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Delirium After Spine Surgery in Older Adults: Incidence, Risk Factors, and Outcomes
Author(s) -
Brown Charles H.,
LaFlam Andrew,
Max Laura,
Wyrobek Julie,
Neufeld Karin J.,
Kebaish Khaled M.,
Cohen David B.,
Walston Jeremy D.,
Hogue Charles W.,
Riley Lee H.
Publication year - 2016
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.14434
Subject(s) - delirium , medicine , odds ratio , incidence (geometry) , confidence interval , prospective cohort study , risk factor , odds , physical therapy , emergency medicine , intensive care medicine , logistic regression , physics , optics
Objectives To characterize the incidence, risk factors, and consequences of delirium in older adults undergoing spine surgery. Design Prospective observational study. Setting Academic medical center. Participants Individuals aged 70 and older undergoing spine surgery (N = 89). Measurements Postoperative delirium and delirium severity were assessed using validated methods, including the Confusion Assessment Method ( CAM ), CAM for the Intensive Care Unit, Delirium Rating Scale‐Revised‐98, and chart review. Hospital‐based outcomes were obtained from the medical record and hospital charges from data reported to the state. Results Thirty‐six participants (40.5%) developed delirium after spine surgery, with 17 (47.2%) having purely hypoactive features. Independent predictors of delirium were lower baseline cognition, higher average baseline pain, more intravenous fluid administered, and baseline antidepressant medication. In adjusted models, the development of delirium was independently associated with higher quintile of length of stay (odds ratio ( OR ) = 3.66, 95% confidence interval ( CI ) = 1.48–9.04, P = .005), higher quintile of hospital charges ( OR = 3.49, 95% CI = 1.35–9.00, P = .01), and lower odds of discharge to home ( OR = 0.22, 95% CI = 0.07–0.69, P = .009). Severity of delirium was associated with higher quintile of hospital charges and lower odds of discharge to home. Conclusion Delirium is common after spine surgery in older adults, and baseline pain is an independent risk factor. Delirium is associated with longer stay, higher charges, and lower odds of discharge to home. Thus, prevention of delirium after spine surgery may be an important quality improvement goal.