Abstract
BackgroundA common postoperative complication found among patients who are critically ill is delirium, which has a high mortality rate. A predictive model is needed to identify high-risk patients in order to apply strategies which will prevent and/or reduce adverse outcomes.ObjectivesTo identify the incidence of, and the risk factors for, postoperative delirium (POD) in surgical intensive care unit (SICU) patients, and to determine predictive scores for the development of POD.MethodsThis study enrolled adults aged over 18 years who had undergone an operation within the preceding week and who had been admitted to a SICU for a period that was expected to be longer than 24 h. The CAM − ICU score was used to determine the occurrence of delirium.ResultsOf the 250 patients enrolled, delirium was found in 61 (24.4%). The independent risk factors for delirium that were identified by a multivariate analysis comprised age, diabetes mellitus, severity of disease (SOFA score), perioperative use of benzodiazepine, and mechanical ventilation. A predictive score (age + (5 × SOFA) + (15 × Benzodiazepine use) + (20 × DM) + (20 × mechanical ventilation) + (20 × modified IQCODE > 3.42)) was created. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.84 (95% CI: 0.786 to 0.897). The cut point of 125 demonstrated a sensitivity of 72.13% and a specificity of 80.95%, and the hospital mortality rate was significantly greater among the delirious than the non-delirious patients (25% vs. 6%, p < 0.01).ConclusionsPOD was experienced postoperatively by a quarter of the surgical patients who were critically ill. A risk score utilizing 6 variables was able to predict which patients would develop POD. The identification of high-risk patients following SICU admission can provide a basis for intervention strategies to improve outcomes.Trial registrationThai Clinical Trials Registry TCTR20181204006. Date registered on December 4, 2018. Retrospectively registered.
Highlights
A common postoperative complication found among patients who are critically ill is delirium, which has a high mortality rate
The identification of high-risk patients following surgical intensive care unit (SICU) admission can provide a basis for intervention strategies to improve outcomes
PPV, positive predictive value; NPV, negative predictive value; LR+, positive likelihood ratio; LR, negative likelihood ratio; AUC, area under curve; 95% CI, 95% confidence interval The optimum cut-off point to discriminate between a high and low probability of postoperative delirium was 125 with the highest Youden'd Index, the best AUC and the optimum sensitivity and specificity
Summary
A common postoperative complication found among patients who are critically ill is delirium, which has a high mortality rate. In a study of the incidence of, and risk factors for, delirium among older patients who had been admitted for hip surgery at a single academic hospital, Muangpaisan et al [12] found that delirium occurred during the pre- and postoperative periods (22.5%). As to the critically ill surgical population, a multicenter, prospective cohort study conducted at 9 academic institutions across Thailand reported a delirium incidence in surgical ICUs of only 3.6% (162/4450, 95% CI 3.09%–4.19%) [14]. Only a single assessment of delirium was performed each day (much less often than advised by guidelines) [15], and the correlation among the delirium assessors was not verified These 2 factors could have resulted in the incidence being underestimated
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