Postoperative delirium in critically ill surgical patients: incidence, risk factors, and predictive scores

• Published in: BMC anesthesiology Vol. 19; no. 1; p. 39
• Main Authors: Chaiwat, Onuma, Chanidnuan, Mellada, Pancharoen, Worapat, Vijitmala, Kittiya, Danpornprasert, Praniti, Toadithep, Puriwat, Thanakiattiwibun, Chayanan
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 20.03.2019; BioMed Central; BMC
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia; Benzodiazepines; Clinical trials; Cohort Studies; Critical Illness; Delirium; Delirium - epidemiology; Delirium - etiology; Diabetes; Diabetes mellitus; Female; Health aspects; Health risk assessment; Hospital Mortality; Hospital patients; Humans; Incidence; Intensive care; Intensive care unit (ICU); Intensive Care Units; Male; Mechanical ventilation; Medical research; Medicine, Experimental; Mental disorders; Middle Aged; Mortality; Multivariate analysis; Older people; Physical restraints; Postoperative Complications - epidemiology; Postoperative delirium; Prediction models; Prospective Studies; Respiration, Artificial - statistics & numerical data; Risk Factors; Risk groups; Surgery; Thailand; Postoperative delirium; Intensive care unit (ICU); Surgery; Risk factors
• ISSN: 1471-2253; 1471-2253
• DOI: 10.1186/s12871-019-0694-x

A common postoperative complication found among patients who are critically ill is delirium, which has a high mortality rate. A predictive model is needed to identify high-risk patients in order to apply strategies which will prevent and/or reduce adverse outcomes. To identify the incidence of, and the risk factors for, postoperative delirium (POD) in surgical intensive care unit (SICU) patients, and to determine predictive scores for the development of POD. This study enrolled adults aged over 18 years who had undergone an operation within the preceding week and who had been admitted to a SICU for a period that was expected to be longer than 24 h. The CAM - ICU score was used to determine the occurrence of delirium. Of the 250 patients enrolled, delirium was found in 61 (24.4%). The independent risk factors for delirium that were identified by a multivariate analysis comprised age, diabetes mellitus, severity of disease (SOFA score), perioperative use of benzodiazepine, and mechanical ventilation. A predictive score (age + (5 × SOFA) + (15 × Benzodiazepine use) + (20 × DM) + (20 × mechanical ventilation) + (20 × modified IQCODE > 3.42)) was created. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.84 (95% CI: 0.786 to 0.897). The cut point of 125 demonstrated a sensitivity of 72.13% and a specificity of 80.95%, and the hospital mortality rate was significantly greater among the delirious than the non-delirious patients (25% vs. 6%, p < 0.01). POD was experienced postoperatively by a quarter of the surgical patients who were critically ill. A risk score utilizing 6 variables was able to predict which patients would develop POD. The identification of high-risk patients following SICU admission can provide a basis for intervention strategies to improve outcomes. Thai Clinical Trials Registry TCTR20181204006 . Date registered on December 4, 2018. Retrospectively registered.