Clinical and Economic Costs of Postoperative Delirium

Postoperative delirium is ssociated with worsened patient outcome and increased resource utilisation.([FOOTNOTE=Abelha FJ, Luis C, Veiga D, et al. Outcome and quality of life in patients with postoperative delirium during an ICU stay following major surgery. Crit Care. 2013;17(5):R257],[ANCHOR=],[LINK=])^,([FOOTNOTE=Gleason LJ, Schmitt EM, Kosar CM, et al. Effect of Delirium and Other Major Complications on Outcomes After Elective Surgery in Older Adults. JAMA Surg. 2015;150(12):1134-1140.],[ANCHOR=],[LINK=])

Postoperative delirium associated mortality

ABELHA 2013

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Abelha 2013

Abelha et al.¹ prospectively enrolled 562 major surgery patients admitted to a surgical intensive care unit. The Intensive Care Delirium Screening Checklist (ICDSC) was used to identify 89 patients (16%) with postoperative delirium. Multivariate analysis with logistic regression model determined that delirium was an independent risk for 6-month mortality and hospital mortality.

	Odds Ratio	P Value
Hospital mortality	2.673	<0.001
Mortality at 6-month	2.562	<0.001
*Adjusted for BMI, body mass index; ASA, American Society of Anesthesiologists; COPD, chronic obstructive pulmonary disease; SICU, surgical intensive care unit; Revised Cardiac Risk Index; APACHE II, Acute Physiology and Chronic Health Evaluation II.

VEIGA 2012

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Veiga 2012

Veiga et al.([FOOTNOTE=Veiga D, Luis C, Parente D, et al. Postoperative delirium in intensive care patients: risk factors and outcome. Rev Bras Anestesiol. 2012;62(4):469-483.],[ANCHOR=],[LINK=]) evaluated 680 major surgery patients for postoperative delirium within 24 hours of admission to the PACU/ICU and then every 8 hours thereafter. 18.8% of patients developed postoperative delirium via the Intensive Care Delirium Screening Checklist (ICDSC). A multivariate regression analysis adjusted for patient factors showed that postoperative delirium was an independent risk factor for hospital mortality.

	Odds ratio	P Value
Hospital mortality	4	< 0.001
Mortality at 6-month	3	< 0.001
*Adjusted to age, ASA Physical status, total Revised Cardiac Risk Index, emergency surgery, hypertension, hyperlipidemia, ischemic heart disease, congestive heart disease, cerebrovascular disease, renal insufficiency, fresh frozen plasma, erythrocytes and troponin I.

RAATS 2015

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232 elderly patients undergoing major surgery underwent evaluation for postoperative delirium.([FOOTNOTE=Raats JW, van Eijsden WA, Crolla RM, Steyerberg EW, van der Laan L. Risk Factors and Outcomes for Postoperative Delirium after Major Surgery in Elderly Patients. PLoS One. 2015;10(8):e0136071.],[ANCHOR=],[LINK=]) Postoperative delirium was identified in 15% of patients via the Delirium Observation Screening Scale. Outcome was compared in patients with and without delirium. Delirium was related to an increased rate of 30-day and 6-month mortality.

Postoperative delirium associated resource utilization

RAATS 2015

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232 elderly patients undergoing major surgery underwent evaluation for postoperative delirium.⁶ Postoperative delirium was identified in 15% of patients via the Delirium Observation Screening Scale. Outcome was compared in patients with and without delirium. Delirium was related to an increased ICU length of stay.

GLEASON 2015

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Gleason 2015

Gleason et al.² investigated the association between delirium and patient outcome in elderly patients (≥ 70 years) undergoing major surgery. 23.9% of 566 patients were diagnosed with postoperative delirium. Postoperative delirium was associated with prolonged length of stay (>5 days), institutional discharge, and rehospitalization with 30 days of discharge.

	Adjusted Relative Risk
Prolonged length of stay (>5 days)	1.9
Institutional discharge	1.5
30-day readmission	2.3
*Adjusted for age, sex, race, Charlson Comorbidity Index score, surgery type (orthopedic vs all others), and anesthesia type (general vs spinal).

BROWN 2016

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Brown et al.([FOOTNOTE=Brown CHt, Laflam A, Max L, et al. The Impact of Delirium After Cardiac Surgical Procedures on Postoperative Resource Use. Ann Thorac Surg. 2016;101(5):1663-1669.],[ANCHOR=],[LINK=]) postoperatively evaluated 66 cardiac surgery patients for postoperative delirium. A propensity score model adjusted for patient related and surgical characteristics found that patients with delirium have greater median hospital charges by $10,339 (p=0.02).

ZYWIEL 2015

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Zywiel 2015

Zywiel et al.([FOOTNOTE=Zywiel MG, Hurley RT, Perruccio AV, Hancock-Howard RL, Coyte PC, Rampersaud YR. Health economic implications of perioperative delirium in older patients after surgery for a fragility hip fracture. J Bone Joint Surg Am. 2015;97(10):829-836.],[ANCHOR=],[LINK=]) evaluated 242 elderly (≥ 65 years) patients undergoing surgical repair of fragility hip fracture at a single institution for postoperative delirium A propensity matching analysis was performed to create matching pairs of patients with delirium and without delirium with similar covariates. Postoperative delirium was associated with increased hospital length of stay and mean episode-of-care cost.

Delirium associated incremental postoperative length of stay	7.4 days
Delirium associated incremental mean episode-of-care cost	8373 USD

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Effect of postoperative delirium on long-term cognitive function

QUINLAN 2011

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Quinlan et al.([FOOTNOTE=Quinlan N, Rudolph JL. Postoperative delirium and functional decline after noncardiac surgery. J Am Geriatr Soc. 2011;59 Suppl 2:S301-304.],[ANCHOR=],[LINK=]) evaluated the social and independent function of 948 non-cardiac surgery patients preoperatively and 3 months postoperatively. Additionally, each patient was assessed for postoperative delirium. A multivariate analysis was performed to determine the association between postoperative delirium and functional decline after adjustment for age, sex, education, cognition, and surgery duration.

KOSTER 2012

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Koster et al.([FOOTNOTE=Koster S, Hensens AG, Schuurmans MJ, van der Palen J. Consequences of delirium after cardiac operations. Ann Thorac Surg. 2012;93(3):705-711.],[ANCHOR=],[LINK=]) assessed perception, memory, and motor function measures in 300 elective cardiac surgery patients 6-months after the procedure. Patients were evaluated for postoperative delirium in the postoperative period. Postoperative delirium was associated with reduced quality of life.

Postoperative delirium associated reductions in quality of life

ABELHA 2013

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Abelha 2013

Abelha et al.⁴ prospectively enrolled 562 major surgery patients admitted to a surgical intensive care unit. The Intensive Care Delirium Screening Checklist (ICDSC) was used to identify 89 patients (16%) with postoperative delirium. Multivariate analysis with logistic regression model was performed to determine the association between postoperative delirium and patient outcome. Delirium was an independent risk for being dependent for personal activities of daily living at 6-months.

	Odds ratio	P Value
Risk of being dependent for personal ADL in patient with delirium	2.188	<0.046

GLEASON 2015

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Gleason 2015

Gleason et al.⁷ investigated the association between delirium and patient outcome in elderly patients (≥ 70 years) undergoing major surgery. 23.9% of 566 patients were diagnosed with postoperative delirium. Postoperative delirium was associated with institutional discharge compared to patients without delirium.

	Adjusted* Relative Risk
Institutional discharge	1.5
* Adjusted for age, sex, race, Charlson Comorbidity Index score, surgery type (orthopedic vs all others), and anesthesia type (general vs spinal).

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Clinical and Economic Burden of Postoperative Delirium

Elude longer and more costly hospital course

Postoperative delirium associated mortality

ABELHA 2013

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Abelha 2013

Adjusted odds ratio* for correlation between delirium and mortality according to multivariate regression model

VEIGA 2012

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Veiga 2012

Adjusted odds ratios* for delirium as a predictor for hospital mortality and 6-month mortality according to multivariate regression analysis.

RAATS 2015

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Raats 2015

Postoperative delirium associated resource utilization

RAATS 2015

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Raats 2015

GLEASON 2015

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Gleason 2015

Contribution of postoperative delirium (adjusted relative risk* ) to prolonged length of stay (>5 days), institutional discharge, and rehospitalization with 30 days of discharge

BROWN 2016

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Brown 2016

ZYWIEL 2015

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Zywiel 2015

Delirium associated incremental mean increase in hospital length of stay and mean episode-of-care cost according to propensity-matched analyses

E-Learning

Discover our broad online education offering.

Effect of postoperative delirium on long-term cognitive function

QUINLAN 2011

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Quinlan 2011

KOSTER 2012

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Koster 2012

Postoperative delirium associated reductions in quality of life

ABELHA 2013

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Abelha 2013

Association between delirium and being dependent for personal activities of daily living at 6-months

GLEASON 2015

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Gleason 2015

Association between delirium and institutional discharge in elderly patients undergoing major surgery

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