A retrospective analysis of the incidence of postoperative delirium and the importance of database selection for its definition
Abstract Background Postoperative delirium (POD) is a common complication after major surgery, resulting in various adverse reactions. However, incidence and risk factors associated with POD after shoulder arthroplasty (SA) have not been well studied using a large-scale national database. Methods A...
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | BMC Psychiatry |
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| Online Access: | https://doi.org/10.1186/s12888-023-04576-4 |
| _version_ | 1811165754897203200 |
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| author | Qinfeng Yang Jinlang Fu Xin Pan Danping Shi Kunlian Li Min Sun Jie Ding Zhanjun Shi Jian Wang |
| author_facet | Qinfeng Yang Jinlang Fu Xin Pan Danping Shi Kunlian Li Min Sun Jie Ding Zhanjun Shi Jian Wang |
| author_sort | Qinfeng Yang |
| collection | DOAJ |
| description | Abstract Background Postoperative delirium (POD) is a common complication after major surgery, resulting in various adverse reactions. However, incidence and risk factors associated with POD after shoulder arthroplasty (SA) have not been well studied using a large-scale national database. Methods A retrospective database analysis was performed based on the Nationwide Inpatient Sample (NIS) from 2005 to 2014, the largest fully paid hospital care database in the United States. Patients undergoing SA were included. The patient’s demographics, comorbidities, length of stay (LOS), total costs, type of insurance, type of hospital, in-hospital mortality, and medical and surgical perioperative complications were assessed. Results A total of 115,147 SA patients were obtained from the NIS database. The general incidence of delirium after SA was 0.89%, peaking in 2010. Patients with delirium after SA had more comorbidities, prolonged LOS, increased hospitalization costs, and higher in-hospital mortality (P < 0.0001). These patients were associated with medical complications during hospitalization, including acute renal failure, acute myocardial infarction, pneumonia, pulmonary embolism, stroke, urinary tract infection, sepsis, continuous invasive mechanical ventilation, blood transfusion, and overall perioperative complications. Risk factors associated with POD include advanced age, neurological disease, depression, psychosis, fluid and electrolyte disturbances, and renal failure. Protective factors include elective hospital admissions and private insurance. Conclusion The incidence of delirium after SA is relatively low. Delirium after SA was associated with increased comorbidities, LOS, overall costs, Medicare coverage, mortality, and perioperative complications. Studying risk factors for POD can help ensure appropriate management and mitigate its consequences. Meanwhile, we found some limitations of this type of research and the need to establish a country-based POD database, including further clearly defining the diagnostic criteria for POD, investigating risk factors and continuing to collect data after discharge (30 days or more), so as to further improve patient preoperative optimization and management. |
| first_indexed | 2024-04-10T15:41:44Z |
| format | Article |
| id | doaj.art-2159773c76524a0e82413a2984051811 |
| institution | Directory Open Access Journal |
| issn | 1471-244X |
| language | English |
| last_indexed | 2024-04-10T15:41:44Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Psychiatry |
| spelling | doaj.art-2159773c76524a0e82413a29840518112023-02-12T12:19:06ZengBMCBMC Psychiatry1471-244X2023-02-0123111210.1186/s12888-023-04576-4A retrospective analysis of the incidence of postoperative delirium and the importance of database selection for its definitionQinfeng Yang0Jinlang Fu1Xin Pan2Danping Shi3Kunlian Li4Min Sun5Jie Ding6Zhanjun Shi7Jian Wang8Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical UniversityDivision of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical UniversityDivision of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical UniversityDepartment of Neurosurgery, Nanfang Hospital, Southern Medical UniversityBeijing Goodwill Hessian Health Technology Co., LtdBeijing Goodwill Hessian Health Technology Co., LtdHuiqiao Medical Center, Nanfang Hospital, Southern Medical UniversityDivision of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical UniversityDivision of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical UniversityAbstract Background Postoperative delirium (POD) is a common complication after major surgery, resulting in various adverse reactions. However, incidence and risk factors associated with POD after shoulder arthroplasty (SA) have not been well studied using a large-scale national database. Methods A retrospective database analysis was performed based on the Nationwide Inpatient Sample (NIS) from 2005 to 2014, the largest fully paid hospital care database in the United States. Patients undergoing SA were included. The patient’s demographics, comorbidities, length of stay (LOS), total costs, type of insurance, type of hospital, in-hospital mortality, and medical and surgical perioperative complications were assessed. Results A total of 115,147 SA patients were obtained from the NIS database. The general incidence of delirium after SA was 0.89%, peaking in 2010. Patients with delirium after SA had more comorbidities, prolonged LOS, increased hospitalization costs, and higher in-hospital mortality (P < 0.0001). These patients were associated with medical complications during hospitalization, including acute renal failure, acute myocardial infarction, pneumonia, pulmonary embolism, stroke, urinary tract infection, sepsis, continuous invasive mechanical ventilation, blood transfusion, and overall perioperative complications. Risk factors associated with POD include advanced age, neurological disease, depression, psychosis, fluid and electrolyte disturbances, and renal failure. Protective factors include elective hospital admissions and private insurance. Conclusion The incidence of delirium after SA is relatively low. Delirium after SA was associated with increased comorbidities, LOS, overall costs, Medicare coverage, mortality, and perioperative complications. Studying risk factors for POD can help ensure appropriate management and mitigate its consequences. Meanwhile, we found some limitations of this type of research and the need to establish a country-based POD database, including further clearly defining the diagnostic criteria for POD, investigating risk factors and continuing to collect data after discharge (30 days or more), so as to further improve patient preoperative optimization and management.https://doi.org/10.1186/s12888-023-04576-4Postoperative deliriumShoulder arthroplastyNationwide inpatient sample |
| spellingShingle | Qinfeng Yang Jinlang Fu Xin Pan Danping Shi Kunlian Li Min Sun Jie Ding Zhanjun Shi Jian Wang A retrospective analysis of the incidence of postoperative delirium and the importance of database selection for its definition BMC Psychiatry Postoperative delirium Shoulder arthroplasty Nationwide inpatient sample |
| title | A retrospective analysis of the incidence of postoperative delirium and the importance of database selection for its definition |
| title_full | A retrospective analysis of the incidence of postoperative delirium and the importance of database selection for its definition |
| title_fullStr | A retrospective analysis of the incidence of postoperative delirium and the importance of database selection for its definition |
| title_full_unstemmed | A retrospective analysis of the incidence of postoperative delirium and the importance of database selection for its definition |
| title_short | A retrospective analysis of the incidence of postoperative delirium and the importance of database selection for its definition |
| title_sort | retrospective analysis of the incidence of postoperative delirium and the importance of database selection for its definition |
| topic | Postoperative delirium Shoulder arthroplasty Nationwide inpatient sample |
| url | https://doi.org/10.1186/s12888-023-04576-4 |
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