The Impact of Delirium After Cardiac Surgical Procedures on Postoperative Resource Use.
The Impact of Delirium After Cardiac Surgical Procedures on Postoperative Resource Use.
复制标题
DOI：
10.1016/j.athoracsur.2015.12.074
复制
发表时间：
2016-05
期刊：
影响因子：
--
通讯作者：
Hogue CW
中科院分区：
文献类型：
--
作者：
Brown CH 4th;Laflam A;Max L;Lymar D;Neufeld KJ;Tian J;Shah AS;Whitman GJ;Hogue CW
谵妄是心脏手术后常见的并发症，与发病率和死亡率的增加有关。然而，严格评估术后谵妄是否与重症监护室（LOS-ICU）住院时间、住院时间（LOS）和住院费用增加相关尚不清楚。接受冠状动脉搭桥术和/或瓣膜手术的患者（n=66）入组一项巢式队列研究。使用意识模糊评估方法进行严格的谵妄评估。LOS-ICU和LOS从病历中获得，医院收费从向国家报告的行政数据中获得。由于结果变量的偏态分布，使用秩和检验以及结合倾向评分的中位数回归来比较结果。发生谵妄的患者（56%）与无谵妄的患者（43%）相比，（75.6小时[IQR 43.6-136.8] vs. 29.7小时[IQR 21.7-46.0]; p=0.002），中位LOS增加（9天[IQR 6-16] vs. 7天[IQR 5-8]; p=0.006），中位住院费用增加（51，805美元[IQR $44，041-$80，238]对比41，576美元[IQR $35，748-$43，660]; P=0.002）。在针对患者和手术特征以及并发症调整的倾向评分模型中，LOS-ICU和成本的结果仍然非常显著，尽管基于特定统计模型，LOS的结果有所减弱。谵妄的严重程度增加与LOS-ICU和收费增加呈剂量反应关系。心脏手术后谵妄与ICU住院时间增加和住院费用增加独立相关。由于谵妄是潜在的预防，有针对性的谵妄预防协议的高风险患者可能是一个重要的战略，提高质量。
Delirium is a common complication after cardiac surgery and is associated with increased morbidity and mortality. However, whether rigorously-assessed postoperative delirium is associated with increased length of stay in the intensive care unit (LOS-ICU), length of stay (LOS), and hospital charges is not clear. Patients (n=66) undergoing coronary artery bypass and/or valve surgery 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 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. Patients who developed delirium (56%) vs. no delirium (43%) had increased median LOS-ICU (75.6 hours [IQR 43.6–136.8] vs. 29.7 hours [IQR 21.7–46.0]; p=0.002), increased median LOS (9 days [IQR 6–16] vs. 7 days [IQR 5–8]; p=0.006), and increased median hospital charges ($51,805 [IQR $44,041-$80,238] vs. $41,576 [IQR $35,748-$43,660]; P=0.002). In propensity score models adjusted for patient and surgical characteristics and complications, the results for LOS-ICU and cost remained highly significant, although the results for LOS were attenuated based on the specific statistical model. Increased severity of delirium was associated with both increased LOS-ICU and charges in a dose-response manner. Delirium after cardiac surgery is independently associated with both increased length of stay-ICU and higher hospital charges. Since delirium is potentially preventable, targeted delirium-prevention protocols for high-risk patients may represent an important strategy for quality improvement.