Effect of Delirium and Other Major Complications on Outcomes After Elective Surgery in Older Adults
Authors
Gleason, Lauren J.Schmitt, Eva
Kosar, Cyrus
Tabloski, Patrica A.
Saczynski, Jane S.
Robinson, Thomas
Cooper, Zara
Rogers, Selwyn O. Jr
Jones, Richard N.
Marcantonio, Edward R.
Inouye, Sharon K.
UMass Chan Affiliations
Department of Medicine, Division of Geriatric MedicineDocument Type
Journal ArticlePublication Date
2015-12-01Keywords
AgedDelirium
Elective Surgical Procedures
Female
Follow-Up Studies
Humans
Incidence
Male
Postoperative Complications
Prognosis
Prospective Studies
Risk Assessment
Risk Factors
United States
Geriatrics
Psychiatry and Psychology
Surgery
Metadata
Show full item recordAbstract
IMPORTANCE: Major postoperative complications and delirium contribute independently to adverse outcomes and high resource use in patients who undergo major surgery; however, their interrelationship is not well examined. OBJECTIVE: To evaluate the association of major postoperative complications and delirium, alone and combined, with adverse outcomes after surgery. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study in 2 large academic medical centers of 566 patients who were 70 years or older without recognized dementia or a history of delirium and underwent elective major orthopedic, vascular, or abdominal surgical procedures with a minimum 3-day hospitalization between June 18, 2010, and August 8, 2013. Data analysis took place from December 13, 2013, through May 1, 2015. MAIN OUTCOMES AND MEASURES: Major postoperative complications, defined as life-altering or life-threatening events (Accordion Severity grade 2 or higher), were identified by expert-panel adjudication. Delirium was measured daily with the Confusion Assessment Method and a validated medical record review method. The following 4 subgroups were analyzed: (1) no complications or delirium; (2) complications only; (3) delirium only; and (4) complications and delirium. Adverse outcomes included a length of stay (LOS) of more than 5 days, institutional discharge, and rehospitalization within 30 days of discharge. RESULTS: In the 566 participants, the mean (SD) age was 76.7 (5.2) years, 236 (41.7%) were male, and 523 (92.4%) were white. Forty-seven patients (8.3%) developed major complications and 135 (23.9%) developed delirium. Compared with no complications or delirium as the reference group, major complications only contributed to prolonged LOS only (relative risk [RR], 2.8; 95% CI, 1.9-4.0); by contrast, delirium only significantly increased all adverse outcomes, including prolonged LOS (RR, 1.9; 95% CI, 1.4-2.7), institutional discharge (RR, 1.5; 95% CI, 1.3-1.7), and 30-day readmission (RR, 2.3; 95% CI, 1.4-3.7). The subgroup with complications and delirium had the highest rates of all adverse outcomes, including prolonged LOS (RR, 3.4; 95% CI, 2.3-4.8), institutional discharge (RR, 1.8; 95% CI, 1.4-2.5), and 30-day readmission (RR, 3.0; 95% CI, 1.3-6.8). Delirium exerted the highest attributable risk at the population level (5.8%; 95% CI, 4.7-6.8) compared with all other adverse events (prolonged LOS, institutional discharge, or readmission). CONCLUSIONS AND RELEVANCE: Major postoperative complications and delirium are separately associated with adverse events and demonstrate a combined effect. Delirium occurs more frequently and has a greater effect at the population level than other major complications.Source
JAMA Surg. 2015 Dec;150(12):1134-40. doi: 10.1001/jamasurg.2015.2606. Link to article on publisher's site.DOI
10.1001/jamasurg.2015.2606Permanent Link to this Item
http://hdl.handle.net/20.500.14038/30658PubMed ID
26352694Related Resources
Link to Article in PubMedRights
Publisher PDF posted after 12 months as allowed by the publisher's author rights policy at http://archsurg.jamanetwork.com/public/instructionsForAuthors.aspx#SecEditorialPoliciesforAuthors.ae974a485f413a2113503eed53cd6c53
10.1001/jamasurg.2015.2606