Delirium After Spine Surgery in Older Adults

Incidence, Risk Factors, and Outcomes

Charles Brown, Andrew LaFlam, Laura Max, Julie Wyrobek, Karin Jane Neufeld, Khaled M Kebaish, David B Cohen, Jeremy D Walston, Charles W. Hogue, Lee H Riley

Research output: Contribution to journalArticle

Abstract

Objectives: To characterize the incidence, risk factors, and consequences of delirium in older adults undergoing spine surgery. Design: Prospective observational study. Setting: Academic medical center. Participants: Individuals aged 70 and older undergoing spine surgery (N = 89). Measurements: Postoperative delirium and delirium severity were assessed using validated methods, including the Confusion Assessment Method (CAM), CAM for the Intensive Care Unit, Delirium Rating Scale-Revised-98, and chart review. Hospital-based outcomes were obtained from the medical record and hospital charges from data reported to the state. Results: Thirty-six participants (40.5%) developed delirium after spine surgery, with 17 (47.2%) having purely hypoactive features. Independent predictors of delirium were lower baseline cognition, higher average baseline pain, more intravenous fluid administered, and baseline antidepressant medication. In adjusted models, the development of delirium was independently associated with higher quintile of length of stay (odds ratio (OR) = 3.66, 95% confidence interval (CI) = 1.48–9.04, P =.005), higher quintile of hospital charges (OR = 3.49, 95% CI = 1.35–9.00, P =.01), and lower odds of discharge to home (OR = 0.22, 95% CI = 0.07–0.69, P =.009). Severity of delirium was associated with higher quintile of hospital charges and lower odds of discharge to home. Conclusion: Delirium is common after spine surgery in older adults, and baseline pain is an independent risk factor. Delirium is associated with longer stay, higher charges, and lower odds of discharge to home. Thus, prevention of delirium after spine surgery may be an important quality improvement goal.

Original languageEnglish (US)
Pages (from-to)2101-2108
Number of pages8
JournalJournal of the American Geriatrics Society
Volume64
Issue number10
DOIs
StatePublished - Oct 1 2016

Fingerprint

Delirium
Spine
Incidence
Hospital Charges
Confusion
Odds Ratio
Confidence Intervals
Pain
Quality Improvement
Cognition
Antidepressive Agents
Medical Records
Observational Studies
Intensive Care Units
Length of Stay
Prospective Studies

Keywords

  • cost
  • delirium
  • outcomes
  • spine surgery

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Delirium After Spine Surgery in Older Adults : Incidence, Risk Factors, and Outcomes. / Brown, Charles; LaFlam, Andrew; Max, Laura; Wyrobek, Julie; Neufeld, Karin Jane; Kebaish, Khaled M; Cohen, David B; Walston, Jeremy D; Hogue, Charles W.; Riley, Lee H.

In: Journal of the American Geriatrics Society, Vol. 64, No. 10, 01.10.2016, p. 2101-2108.

Research output: Contribution to journalArticle

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abstract = "Objectives: To characterize the incidence, risk factors, and consequences of delirium in older adults undergoing spine surgery. Design: Prospective observational study. Setting: Academic medical center. Participants: Individuals aged 70 and older undergoing spine surgery (N = 89). Measurements: Postoperative delirium and delirium severity were assessed using validated methods, including the Confusion Assessment Method (CAM), CAM for the Intensive Care Unit, Delirium Rating Scale-Revised-98, and chart review. Hospital-based outcomes were obtained from the medical record and hospital charges from data reported to the state. Results: Thirty-six participants (40.5{\%}) developed delirium after spine surgery, with 17 (47.2{\%}) having purely hypoactive features. Independent predictors of delirium were lower baseline cognition, higher average baseline pain, more intravenous fluid administered, and baseline antidepressant medication. In adjusted models, the development of delirium was independently associated with higher quintile of length of stay (odds ratio (OR) = 3.66, 95{\%} confidence interval (CI) = 1.48–9.04, P =.005), higher quintile of hospital charges (OR = 3.49, 95{\%} CI = 1.35–9.00, P =.01), and lower odds of discharge to home (OR = 0.22, 95{\%} CI = 0.07–0.69, P =.009). Severity of delirium was associated with higher quintile of hospital charges and lower odds of discharge to home. Conclusion: Delirium is common after spine surgery in older adults, and baseline pain is an independent risk factor. Delirium is associated with longer stay, higher charges, and lower odds of discharge to home. Thus, prevention of delirium after spine surgery may be an important quality improvement goal.",
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