Outcomes Associated With Delirium in Older Patients in Surgical ICUs.
BACKGROUND
We previously noted that older adults admitted to surgical ICUs (SICUs) are at high risk for delirium. In the current study, we describe the association between the presence of delirium and complications in older SICU patients, and describe the association between delirium occurring in the SICU and functional ability and discharge placement for older patients.


METHODS
Secondary analysis of prospective, observational, cohort study. Subjects were 114 consecutive patients >or= 65 years old admitted to a surgical critical care service. All subjects underwent daily delirium and sedation/agitation screening during hospitalization. Outcomes prospectively recorded included SICU complication development, discharge location, and functional ability (as measured by the Katz activities of daily living instrument).


RESULTS
Nearly one third of older adults (31.6%) admitted to an SICU had a complication during ICU stay. There was a strong association between SICU delirium and complication occurrence (p = 0.001). Complication occurrence preceded delirium diagnosis for 16 of 20 subjects. Subjects with delirium in the SICU were more likely to be discharged to a place other than home (61.3% vs 20.5%, p < 0.0001) and have greater functional decline (67.7% vs 43.6%, p = 0.023) than nondelirious subjects. After adjusting for covariates including severity of illness and mechanical ventilation use, delirium was found to be strongly and independently associated with greater odds of being discharged to a place other than home (odds ratio, 7.20; 95% confidence interval, 1.93 to 26.82).


CONCLUSIONS
Delirium in older surgical ICU patients is associated with complications and an increased likelihood of discharge to a place other than home.
Balas
Michele C
MC
University of Pennsylvania School of Nursing, Philadelphia, PA. Electronic address: balasm@nursing.upenn.edu.
Happ
Mary Beth
MB
University of Pittsburgh School of Nursing and Center for Bioethics and Health Law, Pittsburgh, PA.
Yang
Wei
W
Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA.
Chelluri
Lakshmipathi
L
Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Richmond
Therese
T
University of Pennsylvania School of Nursing, Philadelphia, PA.
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003422:Critical Care; D003693:Delirium / Q000150:complications* / Q000628:therapy; D005260:Female; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008297:Male; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D013896:Thoracic Diseases / Q000401:mortality / Q000523:psychology* / Q000601:surgery*; D016896:Treatment Outcome