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Open Access 01-10-2013 | Research

Outcome and quality of life in patients with postoperative delirium during an ICU stay following major surgery

Authors: Fernando J Abelha, Clara Luís, Dalila Veiga, Daniela Parente, Vera Fernandes, Patrícia Santos, Miguela Botelho, Alice Santos, Cristina Santos

Published in: Critical Care | Issue 5/2013

Abstract

Introduction

Delirium is an acute disturbance of consciousness and cognition that has been shown to be associated with poor outcomes, including increased mortality. We aimed to evaluate outcome after postoperative delirium in a cohort of surgical intensive care unit (SICU) patients.

Methods

This prospective study was conducted over a 10-month period in a SICU. Postoperative delirium was diagnosed in accordance with the Intensive Care Delirium Screening Checklist (ICDSC). The primary outcome was mortality at 6-month follow-up. Hospital mortality and becoming dependent were considered as secondary outcomes, on the basis of the evaluation of the patient’s ability to undertake both personal and instrumental activities of daily living (ADL) before surgery and 6 months after discharge from the SICU. For each dichotomous outcome - hospital mortality, mortality at 6-month follow-up, and becoming dependent - a separate multiple logistic regression analysis was performed, which included delirium as an independent variable. Another outcome analyzed was changes in health-related quality of life, as determined using short-form 36 (SF-36), which was administered before and 6 months after discharge from the SICU. Additionally, for each SF-36 domain, a separate multiple linear regression model was used for each SF-36 domain, with changes in the SF-36 domain as a dependent variable and delirium as an independent variable.

Results

Of 775 SICU-admitted adults, 562 were enrolled in the study, of which 89 (16%) experienced postoperative delirium. Delirium was an independent risk factor for mortality at the 6-month follow-up (OR = 2.562, P <0.001) and also for hospital mortality (OR = 2.673, P <0.001). Delirium was also an independent risk factor for becoming dependent for personal ADL (P-ADL) after SICU discharge (OR = 2.188, P <0.046). Moreover, patients who experienced postoperative delirium showed a greater decline in SF-36 domains after discharge, particularly in physical function, vitality, and social function, as compared to patients without postoperative delirium.

Conclusions

Postoperative delirium was an independent risk factor for 6-month follow-up mortality, hospital mortality, and becoming independent in P-ADL after SICU discharge. It was also significantly associated with a worsening in the quality of life after surgery.

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Title: Outcome and quality of life in patients with postoperative delirium during an ICU stay following major surgery
Authors: Fernando J Abelha
Clara Luís
Dalila Veiga
Daniela Parente
Vera Fernandes
Patrícia Santos
Miguela Botelho
Alice Santos
Cristina Santos
Publication date: 01-10-2013
Publisher: BioMed Central
Published in: Critical Care / Issue 5/2013
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc13084

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Outcome and quality of life in patients with postoperative delirium during an ICU stay following major surgery

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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