Charles H Brown1, Andrew Laflam2, Laura Max2, Daria Lymar2, Karin J Neufeld3, Jing Tian4, Ashish S Shah5, Glenn J Whitman6, Charles W Hogue2. 1. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore. Electronic address: cbrownv@jhmi.edu. 2. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore. 3. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore. 4. Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 5. Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. 6. Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore.
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.
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.
Authors: Elizabeth L Whitlock; Brian A Torres; Nan Lin; Daniel L Helsten; Molly R Nadelson; George A Mashour; Michael S Avidan Journal: Anesth Analg Date: 2014-04 Impact factor: 5.108
Authors: S K Inouye; S T Bogardus; P A Charpentier; L Leo-Summers; D Acampora; T R Holford; L M Cooney Journal: N Engl J Med Date: 1999-03-04 Impact factor: 91.245
Authors: James L Rudolph; Sharon K Inouye; Richard N Jones; Frances M Yang; Tamara G Fong; Sue E Levkoff; Edward R Marcantonio Journal: J Am Geriatr Soc Date: 2010-03-22 Impact factor: 5.562
Authors: Karin J Neufeld; Archana Nelliot; Sharon K Inouye; E Wesley Ely; O Joseph Bienvenu; Hochang Benjamin Lee; Dale M Needham Journal: Am J Geriatr Psychiatry Date: 2014-03-15 Impact factor: 4.105
Authors: John A McPherson; Chad E Wagner; Leanne M Boehm; J David Hall; Daniel C Johnson; Leanna R Miller; Kathleen M Burns; Jennifer L Thompson; Ayumi K Shintani; E Wesley Ely; Pratik P Pandharipande; Pratik P Pandhvaripande Journal: Crit Care Med Date: 2013-02 Impact factor: 7.598
Authors: James L Rudolph; Richard N Jones; Sue E Levkoff; Christopher Rockett; Sharon K Inouye; Frank W Sellke; Shukri F Khuri; Lewis A Lipsitz; Basel Ramlawi; Sidney Levitsky; Edward R Marcantonio Journal: Circulation Date: 2008-12-31 Impact factor: 29.690
Authors: Charles H Brown; Karin J Neufeld; Jing Tian; Julia Probert; Andrew LaFlam; Laura Max; Daijiro Hori; Yohei Nomura; Kaushik Mandal; Ken Brady; Charles W Hogue; Ashish Shah; Kenton Zehr; Duke Cameron; John Conte; O Joseph Bienvenu; Rebecca Gottesman; Atsushi Yamaguchi; Michael Kraut Journal: JAMA Surg Date: 2019-09-01 Impact factor: 14.766
Authors: Alvin Thomas; Christine E Haugen; Alexandra Mountford; Fatima Warsame; Rachel Berkowitz; Sunjae Bae; Charles H Brown; Daniel C Brennan; Karin J Neufeld; Michelle C Carlson; Dorry L Segev; Mara McAdams-DeMarco Journal: J Am Soc Nephrol Date: 2018-04-23 Impact factor: 10.121
Authors: S Hesse; M Kreuzer; D Hight; A Gaskell; P Devari; D Singh; N B Taylor; M K Whalin; S Lee; J W Sleigh; P S García Journal: Br J Anaesth Date: 2018-10-25 Impact factor: 9.166
Authors: Charles H Brown; Julia Probert; Ryan Healy; Michelle Parish; Yohei Nomura; Atsushi Yamaguchi; Jing Tian; Kenton Zehr; Kaushik Mandal; Vidyulata Kamath; Karin J Neufeld; Charles W Hogue Journal: Anesthesiology Date: 2018-09 Impact factor: 7.892
Authors: Katrina Kalantar; Sara C LaHue; Joseph L DeRisi; Hannah A Sample; Caitlin A Contag; Scott A Josephson; Michael R Wilson; Vanja C Douglas Journal: J Geriatr Psychiatry Neurol Date: 2018-07-10 Impact factor: 2.680
Authors: Stacie Deiner; Xiaodong Luo; Hung-Mo Lin; Daniel I Sessler; Leif Saager; Frederick E Sieber; Hochang B Lee; Mary Sano; Christopher Jankowski; Sergio D Bergese; Keith Candiotti; Joseph H Flaherty; Harendra Arora; Aryeh Shander; Peter Rock Journal: JAMA Surg Date: 2017-08-16 Impact factor: 14.766
Authors: Patrick Smith; Jillian C Thompson; Elena Perea; Brian Wasserman; Lauren Bohannon; Alessandro Racioppi; Taewoong Choi; Cristina Gasparetto; Mitchell E Horwitz; Gwynn Long; Richard Lopez; David A Rizzieri; Stefanie Sarantopoulos; Keith M Sullivan; Nelson J Chao; Anthony D Sung Journal: Biol Blood Marrow Transplant Date: 2020-09-19 Impact factor: 5.742
Authors: Jan Menzenbach; Stilla Frede; Janine Petras; Vera Guttenthaler; Andrea Kirfel; Claudia Neumann; Andreas Mayr; Maria Wittmann; Mark Coburn; Sven Klaschik; Tobias Hilbert Journal: Biomedicines Date: 2021-05-15