Abstract
Purpose Delirium frequently affects critically ill patients in the intensive care unit (ICU). The purpose of this study is to evaluate the impact of delirium on ICU and hospital length of stay (LOS) and perform a cost analysis. Materials and Methods Prospective studies and randomized controlled trials of patients in the ICU with delirium published between January 1, 2015, and December 31, 2020, were evaluated. Outcome variables including ICU and hospital LOS were obtained, and ICU and hospital costs were derived from the respective LOS. Results Forty-one studies met inclusion criteria. The mean difference of ICU LOS between patients with and without delirium was significant at 4.77 days (p < 0.001); for hospital LOS, this was significant at 6.67 days (p < 0.001). Cost data were extractable for 27 studies in which both ICU and hospital LOS were available. The mean difference of ICU costs between patients with and without delirium was significant at $3,921 (p < 0.001); for hospital costs, the mean difference was $5,936 (p < 0.001). Conclusion ICU and hospital LOS and associated costs were significantly higher for patients with delirium, compared to those without delirium. Further research is necessary to elucidate other determinants of increased costs and cost-reducing strategies for critically ill patients with delirium. This can provide insight into the required resources for the prevention of delirium, which may contribute to decreasing healthcare expenditure while optimizing the quality of care.
Highlights
Delirium is defined as an acute, fluctuating disturbance in attention and awareness, with additional alterations in cognition, not explained by a preexisting neurocognitive disorder or generalized medical condition [1]
Delirium frequently affects critically ill patients in the intensive care unit (ICU). e purpose of this study is to evaluate the impact of delirium on ICU and hospital length of stay (LOS) and perform a cost analysis
Patient care for delirium in the ICU often involves frequent monitoring, extended hospitalization, and increased interventions, including diagnostic testing, pharmacological agents, restraints, and prolonged mechanical ventilation [10,11,12,13,14,15,16,17]. is likely translates into increased costs, which is supported by previous prospective studies demonstrating delirium is associated with up to 40% higher ICU and hospital costs, compared to patients without delirium [11, 12]. erefore, prevention or early identification of delirium in the ICU may represent an area of optimizing healthcare spending and reducing costs
Summary
Delirium is defined as an acute, fluctuating disturbance in attention and awareness, with additional alterations in cognition, not explained by a preexisting neurocognitive disorder or generalized medical condition [1]. Up to 40% of patients in the ICU experience delirium, of which 60–90% are mechanically ventilated [2,3,4,5,6]. Patients that experience delirium within the ICU have worse outcomes, including higher mortality, increased rates of mechanical ventilation, and longer length of stay (LOS) [4, 6,7,8,9]. Patient care for delirium in the ICU often involves frequent monitoring, extended hospitalization, and increased interventions, including diagnostic testing, pharmacological agents, restraints, and prolonged mechanical ventilation [10,11,12,13,14,15,16,17]. While previous review articles have analyzed the effect of delirium on clinically relevant ICU outcomes including LOS and mortality, no review articles to our knowledge have reviewed the influence of delirium on ICU costs [9, 18]. e purpose of this study is to evaluate the influence of delirium on ICU and hospital LOS and associated costs, in a narrative review and cost analysis
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