The Impact of Delirium after Cardiac Surgical Procedures on Postoperative Resource Use

Charles Brown, Andrew Laflam, Laura Max, Daria Lymar, Karin Jane Neufeld, Jing Tian, Ashish S. Shah, Glenn Whitman, Charles W. Hogue

Research output: Contribution to journalArticle

Abstract

Background Delirium is a common complication after cardiac surgical procedures and is associated with increased morbidity and mortality. However, whether rigorously assessed postoperative delirium is associated with an increased length of stay in the intensive care unit (LOS-ICU), length of stay (LOS), and hospital charges is not clear. Methods Patients (n = 66) undergoing coronary artery bypass or valve operations, or both, were enrolled in a nested cohort study. Rigorous delirium assessments were conducted using the Confusion Assessment Method. LOS-ICU and LOS were obtained from the medical record, and hospital charges were obtained from administrative data reported to the state. Because of the skewed distribution of outcome variables, outcomes were compared using rank-sum tests, as well as median regression incorporating propensity scores. Results Patients who developed delirium (56%) versus no delirium (43%) had increased median LOS-ICU (75.6 hours [interquartile range (IQR): 43.6 to 136.8] vs. 29.7 hours [IQR: 21.7 to 46.0]; p = 0.002), increased median LOS (9 days [IQR: 6 to 16] vs. 7 days [IQR: 5 to 8]; p = 0.006), and increased median hospital charges ($51,805 [IQR: $44,041 to $80,238] vs. $41,576 [IQR: $35,748 to $43,660]; p = 0.002). In propensity score models adjusted for patient-related and surgical characteristics and complications, the results for LOS-ICU and cost remained highly significant, although the results for LOS were attenuated on the basis of the specific statistical model. Increased severity of delirium was associated with both increased LOS-ICU and increased charges in a dose-response manner. Conclusions Delirium after cardiac surgical procedures is independently associated with both increased LOS-ICU and higher hospital charges. Because delirium is potentially preventable, targeted delirium-prevention protocols for high-risk patients may represent an important strategy for quality improvement.

Original languageEnglish (US)
Pages (from-to)1663-1669
Number of pages7
JournalAnnals of Thoracic Surgery
Volume101
Issue number5
DOIs
StatePublished - May 1 2016

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Cardiac Surgical Procedures
Delirium
Length of Stay
Hospital Charges
Intensive Care Units
Propensity Score
Confusion
Statistical Models
Nonparametric Statistics
Quality Improvement
Coronary Artery Bypass
Medical Records
Cohort Studies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

The Impact of Delirium after Cardiac Surgical Procedures on Postoperative Resource Use. / Brown, Charles; Laflam, Andrew; Max, Laura; Lymar, Daria; Neufeld, Karin Jane; Tian, Jing; Shah, Ashish S.; Whitman, Glenn; Hogue, Charles W.

In: Annals of Thoracic Surgery, Vol. 101, No. 5, 01.05.2016, p. 1663-1669.

Research output: Contribution to journalArticle

Brown, Charles ; Laflam, Andrew ; Max, Laura ; Lymar, Daria ; Neufeld, Karin Jane ; Tian, Jing ; Shah, Ashish S. ; Whitman, Glenn ; Hogue, Charles W. / The Impact of Delirium after Cardiac Surgical Procedures on Postoperative Resource Use. In: Annals of Thoracic Surgery. 2016 ; Vol. 101, No. 5. pp. 1663-1669.
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abstract = "Background Delirium is a common complication after cardiac surgical procedures and is associated with increased morbidity and mortality. However, whether rigorously assessed postoperative delirium is associated with an increased length of stay in the intensive care unit (LOS-ICU), length of stay (LOS), and hospital charges is not clear. Methods Patients (n = 66) undergoing coronary artery bypass or valve operations, or both, were enrolled in a nested cohort study. Rigorous delirium assessments were conducted using the Confusion Assessment Method. LOS-ICU and LOS were obtained from the medical record, and hospital charges were obtained from administrative data reported to the state. Because of the skewed distribution of outcome variables, outcomes were compared using rank-sum tests, as well as median regression incorporating propensity scores. Results Patients who developed delirium (56{\%}) versus no delirium (43{\%}) had increased median LOS-ICU (75.6 hours [interquartile range (IQR): 43.6 to 136.8] vs. 29.7 hours [IQR: 21.7 to 46.0]; p = 0.002), increased median LOS (9 days [IQR: 6 to 16] vs. 7 days [IQR: 5 to 8]; p = 0.006), and increased median hospital charges ($51,805 [IQR: $44,041 to $80,238] vs. $41,576 [IQR: $35,748 to $43,660]; p = 0.002). In propensity score models adjusted for patient-related and surgical characteristics and complications, the results for LOS-ICU and cost remained highly significant, although the results for LOS were attenuated on the basis of the specific statistical model. Increased severity of delirium was associated with both increased LOS-ICU and increased charges in a dose-response manner. Conclusions Delirium after cardiac surgical procedures is independently associated with both increased LOS-ICU and higher hospital charges. Because delirium is potentially preventable, targeted delirium-prevention protocols for high-risk patients may represent an important strategy for quality improvement.",
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AU - Max, Laura

AU - Lymar, Daria

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AU - Tian, Jing

AU - Shah, Ashish S.

AU - Whitman, Glenn

AU - Hogue, Charles W.

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AB - Background Delirium is a common complication after cardiac surgical procedures and is associated with increased morbidity and mortality. However, whether rigorously assessed postoperative delirium is associated with an increased length of stay in the intensive care unit (LOS-ICU), length of stay (LOS), and hospital charges is not clear. Methods Patients (n = 66) undergoing coronary artery bypass or valve operations, or both, were enrolled in a nested cohort study. Rigorous delirium assessments were conducted using the Confusion Assessment Method. LOS-ICU and LOS were obtained from the medical record, and hospital charges were obtained from administrative data reported to the state. Because of the skewed distribution of outcome variables, outcomes were compared using rank-sum tests, as well as median regression incorporating propensity scores. Results Patients who developed delirium (56%) versus no delirium (43%) had increased median LOS-ICU (75.6 hours [interquartile range (IQR): 43.6 to 136.8] vs. 29.7 hours [IQR: 21.7 to 46.0]; p = 0.002), increased median LOS (9 days [IQR: 6 to 16] vs. 7 days [IQR: 5 to 8]; p = 0.006), and increased median hospital charges ($51,805 [IQR: $44,041 to $80,238] vs. $41,576 [IQR: $35,748 to $43,660]; p = 0.002). In propensity score models adjusted for patient-related and surgical characteristics and complications, the results for LOS-ICU and cost remained highly significant, although the results for LOS were attenuated on the basis of the specific statistical model. Increased severity of delirium was associated with both increased LOS-ICU and increased charges in a dose-response manner. Conclusions Delirium after cardiac surgical procedures is independently associated with both increased LOS-ICU and higher hospital charges. Because delirium is potentially preventable, targeted delirium-prevention protocols for high-risk patients may represent an important strategy for quality improvement.

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