Incidence of Delirium Among Patients Undergoing Elective vs. Emergent Bowel Resection
Ryan Desrochers1, Jonathan D. Gates4, Robert S. Dicks3, Daniel Ricaurte2, Lindsay Lynch4, Jane Keating2, Gary Jain4
1General Surgery, UConn Health, Farmington, Connecticut, United States, 2Acute Care Surgery, Hartford Hospital, Hartford, Connecticut, United States, 3Geriatrics, Hartford Hospital, Hartford, Connecticut, United States, 4Surgical Critical Care, Hartford Hospital, Hartford, Connecticut, United States
Objectives: Evaluate the incidence of postoperative delirium in elective versus emergent bowel resection and the impact of postoperative delirium on all patient outcomes and cost.
Design: Retrospective cohort study using a comprehensive, single institution patient registry.
Setting: Single center at a high volume, urban, academic tertiary care hospital.
Patients: All adult patients undergoing either elective or emergent bowel resection over a 3.5-year period (Jan "13 thru June 16") at Hartford Hospital.
Main Outcomes Measures: This study measured the incidence of postoperative delirium in bowel resection patients (via nursing confusion assessment method (CAM) screening tool). We compared incidence of delirium to patient age, emergent vs. elective admission, ICU/step down days, total length of stay, mortality, disposition on discharge, and hospital cost.
Results: 1934 patients underwent bowel resection during the study period with an overall delirium incidence of 8.8%. Among patients with delirium when compared with patients who did not develop delirium, they were more likely to have undergone emergency surgery (21% vs 3%, p<0.05), were more often older (>70 years of age, p<0.05), had increased length of stay (p<0.05), were 5x more likely to be discharged to a skilled nursing facility (p<0.05), and had a significantly more expensive hospitalization with an annual hospital cost of $770,000 attributed to prolonged length of stay secondary to delirium (p<0.05). Additionally, overall mortality was 14% in patients experiencing delirium vs. 0.1% in patient with no delirium days (p<0.05). Importantly, when broken down between elective and emergency groups, the mortality of those experiencing delirium was similar among the two groups (11 vs. 13%).
Conclusions: The development of delirium among patients post-operatively following bowel resection is an important risk factor for worsened outcomes and mortality. Although the incidence of delirium is higher in the emergency surgery population, the development of delirium in the elective population infers similar risk of mortality. Future research will focus on timing of delirium onset and associated risk and cause of mortality.
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