title: Delirium affects length of hospital stay after lung transplantation.
abstract: BACKGROUND
  Delirium is relatively common after lung transplantation, although its prevalence and prognostic significance have not been systematically studied. The purpose of the present study was to examine pretransplant predictors of delirium and the short-term impact of delirium on clinical outcomes among lung transplant recipients.
  
  
  METHODS
  Participants underwent pretransplant cognitive testing using the Repeatable Battery for the Assessment of Neuropsychological Status and the Trail Making Test. After transplant, delirium was assessed using the Confusion Assessment Method until discharge.
  
  
  RESULTS
  Sixty-three patients were transplanted between March and November 2013, of which 23 (37%) developed delirium. Among transplanted patients, 48 patients completed pretransplant cognitive testing. Better pretransplant cognitive function was associated with lower risk of delirium (odds ratio, 0.69 [95% confidence interval 0.48, 0.99], P = .043); and demographic and clinical features including native disease (P = .236), the Charlson comorbidity index (P = .581), and the lung allocation score (P = .871) were unrelated to risk of delirium, although there was a trend for women to experience delirium less frequently (P = .071). The presence (P = .006) and duration (P = .027) of delirium were both associated with longer hospital stays.
  
  
  CONCLUSIONS
  Delirium occurs in more than one-third of patients after lung transplantation. Delirium was associated with poorer pretransplant cognitive functioning and longer hospital stays, after accounting for other medical and demographic factors.
authors.affiliation: Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC. Electronic address: Patrick.j.smith@dm.duke.edu.
authors.forename: P J
authors.initials: PJ
authors.lastname: Smith
authors.affiliation: Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC.
authors.forename: S K
authors.initials: SK
authors.lastname: Rivelli
authors.affiliation: Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC.
authors.forename: A M
authors.initials: AM
authors.lastname: Waters
authors.affiliation: Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC.
authors.forename: A
authors.initials: A
authors.lastname: Hoyle
authors.affiliation: Duke University Medical Center, Department of Medicine, Durham, NC.
authors.forename: M T
authors.initials: MT
authors.lastname: Durheim
authors.affiliation: Duke University Medical Center, Department of Medicine, Durham, NC.
authors.forename: J M
authors.initials: JM
authors.lastname: Reynolds
authors.affiliation: Duke University Medical Center, Department of Medicine, Durham, NC.
authors.forename: M
authors.initials: M
authors.lastname: Flowers
authors.affiliation: Duke University Medical Center, Department of Surgery, Durham, NC.
authors.forename: R D
authors.initials: RD
authors.lastname: Davis
authors.affiliation: Duke University Medical Center, Department of Medicine, Durham, NC.
authors.forename: S M
authors.initials: SM
authors.lastname: Palmer
authors.affiliation: Duke University Medical Center, Department of Anesthesiology, Durham, NC.
authors.forename: J P
authors.initials: JP
authors.lastname: Mathew
authors.affiliation: Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC.
authors.forename: J A
authors.initials: JA
authors.lastname: Blumenthal
mesh_terms: D000328:Adult; D000368:Aged; D003071:Cognition; D003221:Confusion / Q000175:diagnosis; D003693:Delirium / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007902:Length of Stay; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D014145:Trail Making Test
keywords: Delirium; Length of hospital stay; Lung transplantation