Eduard E Vasilevskis1,2,3, Rameela Chandrasekhar4, Colin H Holtze5, John Graves6, Theodore Speroff1,3,4, Timothy D Girard7, Mayur B Patel8,9, Christopher G Hughes10, Aize Cao11, Pratik P Pandharipande10,12, E Wesley Ely3,13. 1. Department of Medicine, Division of General Internal Medicine and Public Health, Section of Hospital Medicine, Vanderbilt University School of Medicine. 2. Department of Medicine, Center for Quality of Aging, Vanderbilt University School of Medicine. 3. Geriatric Research, Education and Clinical Center (GRECC), Department of Veterans Affairs Medical. 4. Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN. 5. Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI. 6. Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN. 7. Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. 8. Departments of Surgery, Neurosurgery, and Hearing and Speech Sciences, Section of Surgical Sciences, Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Vanderbilt Brain Institute, Vanderbilt Center for Health Services Research, Critical Illness, Brain dysfunction, and Survivorship Center, Vanderbilt University Medical Center. 9. Surgical Service, General Surgery Section and Geriatric Research, Education, and Clinical Center (GRECC), Nashville VA Medical Center, Tennessee Valley Healthcare System, US Department of Veterans Affairs. 10. Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine. 11. Department of Biomedical Informatics, Center for Population Health Informatics, Vanderbilt University School of Medicine. 12. Department of Veterans Affairs Medical Center, Anesthesia Service, Tennessee Valley Healthcare System. 13. Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN.
Abstract
RATIONALE: Intensive care unit (ICU) delirium is highly prevalent and a potentially avoidable hospital complication. The current cost of ICU delirium is unknown. OBJECTIVES: To specify the association between the daily occurrence of delirium in the ICU with costs of ICU care accounting for time-varying illness severity and death. RESEARCH DESIGN: We performed a prospective cohort study within medical and surgical ICUs in a large academic medical center. SUBJECTS: We analyzed critically ill patients (N=479) with respiratory failure and/or shock. MEASURES: Covariates included baseline factors (age, insurance, cognitive impairment, comorbidities, Acute Physiology and Chronic Health Evaluation II Score) and time-varying factors (sequential organ failure assessment score, mechanical ventilation, and severe sepsis). The primary analysis used a novel 3-stage regression method: first, estimation of the cumulative cost of delirium over 30 ICU days and then costs separated into those attributable to increased resource utilization among survivors and those that were avoided on the account of delirium's association with early mortality in the ICU. RESULTS: The patient-level 30-day cumulative cost of ICU delirium attributable to increased resource utilization was $17,838 (95% confidence interval, $11,132-$23,497). A combination of professional, dialysis, and bed costs accounted for the largest percentage of the incremental costs associated with ICU delirium. The 30-day cumulative incremental costs of ICU delirium that were avoided due to delirium-associated early mortality was $4654 (95% confidence interval, $2056-7869). CONCLUSIONS: Delirium is associated with substantial costs after accounting for time-varying illness severity and could be 20% higher (∼$22,500) if not for its association with early ICU mortality.
RATIONALE: Intensive care unit (ICU) delirium is highly prevalent and a potentially avoidable hospital complication. The current cost of ICU delirium is unknown. OBJECTIVES: To specify the association between the daily occurrence of delirium in the ICU with costs of ICU care accounting for time-varying illness severity and death. RESEARCH DESIGN: We performed a prospective cohort study within medical and surgical ICUs in a large academic medical center. SUBJECTS: We analyzed critically ill patients (N=479) with respiratory failure and/or shock. MEASURES: Covariates included baseline factors (age, insurance, cognitive impairment, comorbidities, Acute Physiology and Chronic Health Evaluation II Score) and time-varying factors (sequential organ failure assessment score, mechanical ventilation, and severe sepsis). The primary analysis used a novel 3-stage regression method: first, estimation of the cumulative cost of delirium over 30 ICU days and then costs separated into those attributable to increased resource utilization among survivors and those that were avoided on the account of delirium's association with early mortality in the ICU. RESULTS: The patient-level 30-day cumulative cost of ICU delirium attributable to increased resource utilization was $17,838 (95% confidence interval, $11,132-$23,497). A combination of professional, dialysis, and bed costs accounted for the largest percentage of the incremental costs associated with ICU delirium. The 30-day cumulative incremental costs of ICU delirium that were avoided due to delirium-associated early mortality was $4654 (95% confidence interval, $2056-7869). CONCLUSIONS:Delirium is associated with substantial costs after accounting for time-varying illness severity and could be 20% higher (∼$22,500) if not for its association with early ICU mortality.
Authors: Eduard E Vasilevskis; E Wesley Ely; Theodore Speroff; Brenda T Pun; Leanne Boehm; Robert S Dittus Journal: Chest Date: 2010-11 Impact factor: 9.410
Authors: E W Ely; S K Inouye; G R Bernard; S Gordon; J Francis; L May; B Truman; T Speroff; S Gautam; R Margolin; R P Hart; R Dittus Journal: JAMA Date: 2001-12-05 Impact factor: 56.272
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 C Jackson; Pratik P Pandharipande; Timothy D Girard; Nathan E Brummel; Jennifer L Thompson; Christopher G Hughes; Brenda T Pun; Eduard E Vasilevskis; Alessandro Morandi; Ayumi K Shintani; Ramona O Hopkins; Gordon R Bernard; Robert S Dittus; E Wesley Ely Journal: Lancet Respir Med Date: 2014-04-07 Impact factor: 30.700
Authors: Pratik P Pandharipande; Brenda T Pun; Daniel L Herr; Mervyn Maze; Timothy D Girard; Russell R Miller; Ayumi K Shintani; Jennifer L Thompson; James C Jackson; Stephen A Deppen; Renee A Stiles; Robert S Dittus; Gordon R Bernard; E Wesley Ely Journal: JAMA Date: 2007-12-12 Impact factor: 56.272
Authors: Timothy D Girard; John P Kress; Barry D Fuchs; Jason W W Thomason; William D Schweickert; Brenda T Pun; Darren B Taichman; Jan G Dunn; Anne S Pohlman; Paul A Kinniry; James C Jackson; Angelo E Canonico; Richard W Light; Ayumi K Shintani; Jennifer L Thompson; Sharon M Gordon; Jesse B Hall; Robert S Dittus; Gordon R Bernard; E Wesley Ely Journal: Lancet Date: 2008-01-12 Impact factor: 79.321
Authors: Heidi Lindroth; Babar A Khan; Janet S Carpenter; Sujuan Gao; Anthony J Perkins; Sikandar H Khan; Sophia Wang; Richard N Jones; Malaz A Boustani Journal: Ann Am Thorac Soc Date: 2020-09
Authors: Michael R Chomat; Ahmed S Said; Jessica L Mann; Michael Wallendorf; Alexandra Bickhaus; Mayte Figueroa Journal: Pediatr Cardiol Date: 2021-04-23 Impact factor: 1.655
Authors: Timothy D Girard; Matthew C Exline; Shannon S Carson; Catherine L Hough; Peter Rock; Michelle N Gong; Ivor S Douglas; Atul Malhotra; Robert L Owens; Daniel J Feinstein; Babar Khan; Margaret A Pisani; Robert C Hyzy; Gregory A Schmidt; William D Schweickert; R Duncan Hite; David L Bowton; Andrew L Masica; Jennifer L Thompson; Rameela Chandrasekhar; Brenda T Pun; Cayce Strength; Leanne M Boehm; James C Jackson; Pratik P Pandharipande; Nathan E Brummel; Christopher G Hughes; Mayur B Patel; Joanna L Stollings; Gordon R Bernard; Robert S Dittus; E Wesley Ely Journal: N Engl J Med Date: 2018-10-22 Impact factor: 91.245
Authors: Katarzyna Kotfis; Shawniqua Williams Roberson; Jo Wilson; Brenda Pun; E Wesley Ely; Ilona Jeżowska; Maja Jezierska; Wojciech Dabrowski Journal: Anaesthesiol Intensive Ther Date: 2020
Authors: Matthew F Mart; Brenda T Pun; Pratik Pandharipande; James C Jackson; E Wesley Ely Journal: Crit Care Med Date: 2021-08-01 Impact factor: 9.296
Authors: Miguel García-Grimshaw; Erwin Chiquete; Amado Jiménez-Ruiz; José de Jesús Vidal-Mayo; Samara Lissete Grajeda-González; María de Los Ángeles Vargas-Martínez; Liz Nicole Toapanta-Yanchapaxi; Sergio Iván Valdés-Ferrer; Oswaldo Alan Chávez-Martínez; Osvaldo Alexis Marché-Fernández; Ana Itiel Jiménez-Ávila; Carlos Cantú-Brito; Fernando Daniel Flores-Silva Journal: J Acad Consult Liaison Psychiatry Date: 2021-07-06