Comprehensive analysis of in-hospital delirium after major surgical oncology procedures: A population-based study

  • Marco Bandini Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
  • Michele Marchioni Department of Urology, SS Annunziata Hospital, "G. D'Annunzio" University of Chieti, Chieti, Italy
  • Felix Preisser Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  • Sebastiano Nazzani Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
  • Zhe Tian Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Division of Urology, CHUM, Montréal, Québec, Canada
  • Markus Graefen Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  • Francesco Montorsi Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
  • Fred Saad Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Division of Urology, CHUM, Montréal, Québec, Canada
  • Shahrokh F. Shariat Department of Urology, Medical University of Vienna, Vienna, Austria
  • Luigi Schips Department of Urology, SS Annunziata Hospital, "G. D'Annunzio" University of Chieti, Chieti, Italy
  • Alberto Briganti Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
  • Pierre I. Karakiewicz Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Division of Urology, CHUM, Montréal, Québec, Canada
Keywords: Nationwide Inpatient Sample; Delirium; Major surgical oncology procedure; In-hospital mortality; Population-based.

Abstract

Introduction: Very few population-based assessments of delirium have been performed to date. These have not assessed the implications of delirium after major surgical oncology procedures (MSOPs). We examined the temporal trends of delirium following 10 MSOPs, as well as patient and hospital delirium risk factors. Finally, we examined the effect of delirium on length of stay, in-hospital mortality, and hospital charges.

Methods: We retrospectively identified patients who underwent prostatectomy, colectomy, cystectomy, mastectomy, gastrectomy, hysterectomy, nephrectomy, oophorectomy, lung resection, or pancreatectomy within the Nationwide Inpatient Sample (2003‒2013). We yielded a weighted estimate of 3 431 632 patients. Multivariable logistic regression (MLR) analyses identified the determinants of postoperative delirium, as well as the effect of delirium on length of stay, in-hospital mortality, and hospital charges.

Results: Between 2003 and 2013, annual delirium rate increased from 0.7 to 1.2% (+6.0%; p<0.001). Delirium rates were highest after cystectomy (predicted probability [PP] 3.1%) and pancreatectomy (PP 2.6%), and lowest after prostatectomy (PP 0.15%) and mastectomy (PP 0.13%). Advanced age (odds ratio [OR] 3.80), maleness (OR 1.38), and higher Charlson comorbidity index (OR 1.20), as well as postoperative complications, represent risk factors for delirium after MSOPs. Delirium after MSOP was associated with prolonged length of stay (OR 3.00), higher mortality (OR 1.15), and increased in-hospital charges (OR 1.13).

Conclusions: No contemporary population-based assessments of delirium after MSOP have been reported. According to our findings, delirium after MSOP has a profound impact on patient outcomes that ranges from prolonged length of stay to higher mortality and increased in-hospital charges.

Published
2019-09-27
How to Cite
Bandini, M., Marchioni, M., Preisser, F., Nazzani, S., Tian, Z., Graefen, M., Montorsi, F., Saad, F., Shariat, S. F., Schips, L., Briganti, A., & Karakiewicz, P. I. (2019). Comprehensive analysis of in-hospital delirium after major surgical oncology procedures: A population-based study. Canadian Urological Association Journal, 14(3), E84-93. https://doi.org/10.5489/cuaj.6030
Section
Original Research