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 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.

A retrospective analysis of the incidence and risk factors of perioperative urinary tract infections after total hysterectomy

“…The odds ratios (ORs) of baseline parameters and any surgical and medical problems compared between the two groups were computed using binary logistic regression. P < 0.001 was utilized to establish the statistical significance of the alpha level because previous NIS research had used high sample numbers [ 16 ]. Images were drawn using Free Statistics software version 1.9. and pptx.…”

Incidence and risk factors of postoperative pulmonary complications following total hip arthroplasty revision: a retrospective Nationwide Inpatient Sample database study

“…Considering the clinical heterogeneity of PPCs, we investigated risk factors for pneumonia, ARF, and PE separately, utilizing variables identified as risk factors associated with PPCs. Due to the use of a substantial sample size in previous research on NIS, our statistical significance of the alpha level was established to be P ≤ 0.001 [8,10,11].…”

Development of an individualized model for predicting postoperative delirium in elderly patients with hepatocellular carcinoma

“…Recognizing the intrinsic biases inherent in this type of study design is crucial. Prior studies have highlighted several risk factors linked to POD, including preoperative depression and anxiety[63][64][65][66][67][68] . Nevertheless, these factors were not incorporated into our analysis owing to certain constraints.…”