title: Postoperative Delirium in Severely Burned Patients Undergoing Early Escharotomy: Incidence, Risk Factors, and Outcomes.
abstract: The aim of this study is to investigate the incidence, related risk factors, and outcomes of postoperative delirium (POD) in severely burned patients undergoing early escharotomy. This study included 385 severely burned patients (injured <1 week; TBSA, 31-50% or 11-20%; American Society of Anesthesiologists physical status, II-IV) aged 18 to 65 years, who underwent early escharotomy between October 2014 and December 2015, and were selected by cluster sampling. The authors excluded patients with preoperative delirium or diagnosed dementia, depression, or cognitive dysfunction. Preoperative, perioperative, intraoperative, and postoperative information, such as demographic characteristics, vital signs, and health history were collected. The Confusion Assessment Method was used once daily for 5 days after surgery to identify POD. Stepwise binary logistic regression analysis was used to identify the risk factors for POD, t-tests, and χ tests were performed to compare the outcomes of patients with and without the condition. Fifty-six (14.55%) of the patients in the sample were diagnosed with POD. Stepwise binary logistic regression showed that the significant risk factors for POD in severely burned patients undergoing early escharotomy were advanced age (>50 years old), a history of alcohol consumption (>3/week), high American Society of Anesthesiologists classification (III or IV), time between injury and surgery (>2 days), number of previous escharotomies (>2), combined intravenous and inhalation anesthesia, no bispectral index applied, long duration surgery (>180 min), and intraoperative hypotension (mean arterial pressure < 55 mm Hg). On the basis of the different odds ratios, the authors established a weighted model. When the score of a patient's weighted odds ratios is more than 6, the incidence of POD increased significantly (P < .05). When the score of a patient's weighted odds ratios is more than 6, the incidence of POD increased significantly (P < .05). Further, POD was associated with more postoperative complications, including hepatic and renal function impairment and hypernatremia, as well as prolonged hospitalization, increased medical costs, and higher mortality.
authors.affiliation: From the *Department of Anesthesiology, First Affiliated Hospital of General Hospital of PLA, Beijing, China; †Department of Anesthesiology and Critical Care, Perelman School of Medicine, The University of Pennsylvania, Philadelphia; and ‡Department of Nursing, Medical College of Jinhua Polytechnic, Zhejiang, China.
authors.forename: Zhenggang
authors.initials: Z
authors.lastname: Guo
authors.forename: Jiabin
authors.initials: J
authors.lastname: Liu
authors.forename: Jia
authors.initials: J
authors.lastname: Li
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Wang
authors.forename: Hui
authors.initials: H
authors.lastname: Guo
authors.forename: Panpan
authors.initials: P
authors.lastname: Ma
authors.forename: Xiaojun
authors.initials: X
authors.lastname: Su
authors.forename: Ping
authors.initials: P
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002056:Burns / Q000150:complications / Q000523:psychology / Q000601:surgery*; D002921:Cicatrix / Q000209:etiology / Q000523:psychology / Q000601:surgery*; D003693:Delirium / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult