PMID- 27041454
OWN - NLM
STAT- MEDLINE
DCOM- 20170227
LR  - 20220310
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Print)
IS  - 0003-4975 (Linking)
VI  - 101
IP  - 5
DP  - 2016 May
TI  - The Impact of Delirium After Cardiac Surgical Procedures on Postoperative 
      Resource Use.
PG  - 1663-9
LID - S0003-4975(16)00067-9 [pii]
LID - 10.1016/j.athoracsur.2015.12.074 [doi]
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.
CI  - Copyright (c) 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Brown, Charles H 4th
AU  - Brown CH 4th
AD  - Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University 
      School of Medicine, Baltimore. Electronic address: cbrownv@jhmi.edu.
FAU - Laflam, Andrew
AU  - Laflam A
AD  - Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University 
      School of Medicine, Baltimore.
FAU - Max, Laura
AU  - Max L
AD  - Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University 
      School of Medicine, Baltimore.
FAU - Lymar, Daria
AU  - Lymar D
AD  - Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University 
      School of Medicine, Baltimore.
FAU - Neufeld, Karin J
AU  - Neufeld KJ
AD  - Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School 
      of Medicine, Baltimore.
FAU - Tian, Jing
AU  - Tian J
AD  - Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, 
      Baltimore, Maryland.
FAU - Shah, Ashish S
AU  - Shah AS
AD  - Department of Surgery, Vanderbilt University Medical Center, Nashville, 
      Tennessee.
FAU - Whitman, Glenn J
AU  - Whitman GJ
AD  - Division of Cardiac Surgery, Johns Hopkins University School of Medicine, 
      Baltimore.
FAU - Hogue, Charles W
AU  - Hogue CW
AD  - Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University 
      School of Medicine, Baltimore.
LA  - eng
GR  - P30 AG021334/AG/NIA NIH HHS/United States
GR  - P50 AG005146/AG/NIA NIH HHS/United States
GR  - R01 HL092259/HL/NHLBI NIH HHS/United States
GR  - R03 AG042331/AG/NIA NIH HHS/United States
PT  - Journal Article
DEP - 20160331
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Aged
MH  - Cardiac Surgical Procedures/*adverse effects
MH  - Delirium/*economics
MH  - Female
MH  - *Health Resources
MH  - Hospital Charges
MH  - Humans
MH  - Intensive Care Units
MH  - Length of Stay
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/*economics
PMC - PMC5406132
MID - NIHMS752567
COIS- Set conflict box: Dr Neufeld discloses a financial relationship with Ornim 
      Medical; Dr Hogue with Ornim Medical and Covidien, Inc.
EDAT- 2016/04/05 06:00
MHDA- 2017/02/28 06:00
PMCR- 2017/05/01
CRDT- 2016/04/05 06:00
PHST- 2015/07/15 00:00 [received]
PHST- 2015/12/07 00:00 [revised]
PHST- 2015/12/22 00:00 [accepted]
PHST- 2016/04/05 06:00 [entrez]
PHST- 2016/04/05 06:00 [pubmed]
PHST- 2017/02/28 06:00 [medline]
PHST- 2017/05/01 00:00 [pmc-release]
AID - S0003-4975(16)00067-9 [pii]
AID - 10.1016/j.athoracsur.2015.12.074 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2016 May;101(5):1663-9. doi: 10.1016/j.athoracsur.2015.12.074. 
      Epub 2016 Mar 31.