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Abstract
BackgroundDelirium is a well-known complication in cardiac surgery and intensive care unit (ICU) patients. However, in many other settings its prevalence and clinical consequences are understudied. The aims of this study were: (1) To assess delirium prevalence in a large, diverse cohort of acute care patients classified as either at risk or not at risk for delirium; (2) To compare these two groups according to defined indicators; and (3) To compare delirious with non-delirious patients regarding hospital mortality, ICU and hospital length of stay, nursing hours and cost per case.MethodsThis cohort study was performed in a Swiss university hospital following implementation of a delirium management guideline. After excluding patients aged < 18 years or with a length of stay (LOS) < 1 day, 29′278 patients hospitalized in the study hospital in 2014 were included.Delirium period prevalence was calculated based on a Delirium Observation Scale (DOS) score ≥ 3 and / or Intensive Care Delirium Screening Checklist (ICDSC) scores ≥4.ResultsOf 10′906 patients admitted, DOS / ICDSC scores indicated delirium in 28.4%. Delirium was most prevalent (36.2–40.5%) in cardiac surgery, neurosurgery, trauma, radiotherapy and neurology patients. It was also common in geriatrics, internal medicine, visceral surgery, reconstructive plastic surgery and cranio-maxillo-facial surgery patients (prevalence 21.6–28.6%). In the unadjusted and adjusted models, delirious patients had a significantly higher risk of inpatient mortality, stayed significantly longer in the ICU and hospital, needed significantly more nursing hours and generated significantly higher costs per case. For the seven most common ICD-10 diagnoses, each diagnostic group’s delirious patients had worse outcomes compared to those with no delirium.ConclusionsThe results indicate a high number of patients at risk for delirium, with high delirium prevalence across all patient groups. Delirious patients showed significantly worse clinical outcomes and generated higher costs. Subgroup analyses highlighted striking variations in delirium period-prevalence across patient groups. Due to the high prevalence of delirium in patients treated in care centers for radiotherapy, visceral surgery, reconstructive plastic surgery, cranio-maxillofacial surgery and oral surgery, it is recommended to expand the current focus of delirium management to these patient groups.
Highlights
Delirium is a well-known complication in cardiac surgery and intensive care unit (ICU) patients
Whereas patients not at risk were generally admitted as elective cases from home to the hospital, the screened patients, those in delirious states, were more likely to have been transferred from another hospital and / or admitted via emergency admission
Delirium prevalence in different patient subgroups In accordance with the implemented guideline, 10′906 (37.2%) of the total 29′278 patients were identified at risk for delirium and screened
Summary
Delirium is a well-known complication in cardiac surgery and intensive care unit (ICU) patients. The aims of this study were: (1) To assess delirium prevalence in a large, diverse cohort of acute care patients classified as either at risk or not at risk for delirium; (2) To compare these two groups according to defined indicators; and (3) To compare delirious with nondelirious patients regarding hospital mortality, ICU and hospital length of stay, nursing hours and cost per case. In the United States (US), annual additional delirium-related healthcare costs are estimated to range from 6.6 to 20.4 billion USD (mean: 9014 USD per case) in ICU patients [26] and 38 to 152 billion USD per year in non-ICU patients aged 70 years and older (range: 16,303 to 64,421 USD per case) [27]
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