Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Aging Clin Exp Res. 2021 Nov;33(11):3047-3056. doi: 10.1007/s40520-021-01842-x. Epub 2021 Apr 3.
Postoperative delirium (POD) is a relevant and underdiagnosed complication after cardiac surgery that is associated with increased intensive care unit (ICU) and hospital length of stay (LOS). The aim of this subgroup study was to compare the frequency of tested POD versus the coded International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis of POD and to evaluate the influence of POD on LOS in ICU and hospital.
254 elective cardiac surgery patients (mean age, 70.5 ± 6.4 years) at the University Hospital Bonn between September 2018 and October 2019 were evaluated. The endpoint tested POD was considered positive, if one of the tests Confusion Assessment Method for ICU (CAM-ICU) or Confusion Assessment Method (CAM), 4 'A's Test (4AT) or Delirium Observation Scale (DOS) was positive on one day.
POD occurred in 127 patients (50.0%). LOS in ICU and hospital were significantly different based on presence (ICU 165.0 ± 362.7 h; Hospital 26.5 ± 26.1 days) or absence (ICU 64.5 ± 79.4 h; Hospital 14.6 ± 6.7 days) of POD (p < 0.001). The multiple linear regression showed POD as an independent predictor for a prolonged LOS in ICU (48%; 95%CI 31-67%) and in hospital (64%; 95%CI 27-110%) (p < 0.001). The frequency of POD in the study participants that was coded with the ICD F05.0 and F05.8 by hospital staff was considerably lower than tests revealed by the study personnel.
Approximately 50% of elderly patients who underwent cardiac surgery developed POD, which is associated with an increased ICU and hospital LOS. Furthermore, POD is highly underdiagnosed in clinical routine.
术后谵妄（POD）是心脏手术后一个相关且未被充分诊断的并发症，它与重症监护病房（ICU）和住院时间（LOS）的延长有关。本亚组研究的目的是比较测试的 POD 频率与医院编码的国际疾病分类和相关健康问题（ICD）的 POD 诊断，并评估 POD 对 ICU 和医院 LOS 的影响。
2018 年 9 月至 2019 年 10 月，在波恩大学医院评估了 254 名接受择期心脏手术的患者（平均年龄 70.5±6.4 岁）。如果 ICU 中的一项测试（ICU 中的意识模糊评估方法（CAM-ICU）或意识模糊评估方法（CAM）、4‘A’测试（4AT）或谵妄观察量表（DOS）在一天内呈阳性），则将测试的 POD 定义为阳性。
127 名患者（50.0%）发生 POD。基于 POD 的存在（ICU 165.0±362.7 小时；医院 26.5±26.1 天）或不存在（ICU 64.5±79.4 小时；医院 14.6±6.7 天），ICU 和医院的 LOS 有显著差异（p<0.001）。多元线性回归显示，POD 是 ICU （48%；95%CI 31-67%）和医院（64%；95%CI 27-110%） LOS 延长的独立预测因素（p<0.001）。研究人员通过测试发现，接受心脏手术的老年患者中 POD 的发生率（约 50%）显著高于医院工作人员用 ICD F05.0 和 F05.8 编码的发生率。
大约 50%接受心脏手术的老年患者发生 POD，这与 ICU 和医院 LOS 的延长有关。此外，POD 在临床常规中被高度低估。
