Department of Anesthesiology, Toronto General Hospital, Eaton North 3-453, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
Can J Anaesth. 2010 Oct;57(10):898-902. doi: 10.1007/s12630-010-9355-8. Epub 2010 Jul 20.
Administrative electronic databases are highly specific for postoperative complications, but they lack sensitivity. The objective of this study was to determine the incidence of delirium after cardiac surgery using a targeted prospectively collected dataset and to compare the findings with the incidence of delirium in the same cohort of patients identified in a hospital administrative database.
Following Research Ethics Board approval, we compared delirium rates in a prospectively collected data research database with delirium rates in the same cohort of patients in an administrative hospital database where delirium was identified from codes entered by coding and abstracting staff. Every 12 hr postoperatively, delirium was assessed with a Confusion Assessment Method in the Intensive Care Unit. The administrative database contained the International Classification of Diseases version 10 (ICD-10) codes for patient diagnoses. The ICD-10 codes were extracted from the administrative database for each patient in the research database and were checked for the presence of the ICD-10 code for delirium.
Data from a cohort of 1,528 patients were analyzed. Postoperative delirium was identified in 182 (11.9%) patients (95% confidence interval [CI], 10.3-13.5%) in the research dataset and 46 (3%) patients (95% CI, 2.2-3.8%) in the administrative dataset (P < 0.001). Thirteen (0.85%) patients who were coded for delirium in the administrative database were not identified in the research dataset. The median onset of postoperative delirium in these patients was significantly delayed (4 [3-9] days) compared with patients identified by both datasets (2 [1-9] days) and compared with patients from the research database only (1 [1-14] days) (P = 0.007).
Postoperative delirium rates after cardiac surgery are underestimated by the hospital administrative database.
行政电子数据库对术后并发症具有高度特异性，但缺乏敏感性。本研究的目的是使用有针对性的前瞻性收集数据集确定心脏手术后谵妄的发生率，并将结果与同一队列患者在医院行政数据库中确定的谵妄发生率进行比较。
在获得研究伦理委员会批准后，我们将前瞻性收集的数据研究数据库中的谵妄发生率与行政医院数据库中同一队列患者的谵妄发生率进行比较，在行政医院数据库中，由编码和摘要工作人员输入代码来确定谵妄。术后每 12 小时，在重症监护病房使用意识混乱评估方法评估谵妄。行政数据库包含疾病国际分类第 10 版（ICD-10）患者诊断代码。从研究数据库中的每位患者的行政数据库中提取 ICD-10 代码，并检查是否存在 ICD-10 谵妄代码。
对 1528 例患者的队列数据进行了分析。在研究数据集的 182 例（11.9%，95%置信区间[CI]：10.3-13.5%）患者中发现术后谵妄，在行政数据集的 46 例（3%，95%CI：2.2-3.8%）患者中发现术后谵妄（P<0.001）。在行政数据库中被编码为谵妄的 13 例患者在研究数据集中未被识别。这些患者术后谵妄的中位发病时间明显延迟（4[3-9]天），与两组数据集均识别出的患者（2[1-9]天）和仅从研究数据库中识别出的患者（1[1-14]天）相比，差异均有统计学意义（P=0.007）。
心脏手术后术后谵妄发生率被医院行政数据库低估。
