title: The impact of delirium on healthcare utilization and survival after transcatheter aortic valve replacement.
abstract: OBJECTIVE
  We assessed whether post-operative delirium is associated with healthcare utilization and overall survival after trans-catheter aortic valve replacement.
  
  
  BACKGROUND
  Delirium, a common syndrome among hospitalized older adults, is associated with increased morbidity and mortality.
  
  
  METHODS
  We reviewed 294 transcatheter aortic valve replacement cases between June 2008 and February 2015 at a tertiary care academic medical center. Post-operative delirium was identified by confusion assessment method screening and clinician diagnosis.
  
  
  RESULTS
  Delirium was identified in 61 patients (21%). Non-femoral access for trans-catheter aortic valve replacement was more common in delirious patients than in non-delirious patients (41% vs. 27%, P = 0.04). Delirious patients had diminished overall survival after trans-catheter aortic valve replacement compared to non-delirious patients (1-year survival 59% vs. 84%, log-rank P = 0.002). After adjusting for age, Society of Thoracic Surgeons predicted 30-day mortality, and access type; delirium remained independently associated with diminished overall survival (hazard ratio 2.01, 95% confidence interval 1.21-3.33, P = 0.007). The delirium group had longer mean hospital stay (13.3 ± 9.5 days vs. 6.7 ± 3.8 days, P < 0.001) and a higher rate of discharge to a rehabilitation facility (61% vs. 27%, P < 0.001), but there was no difference in 30-day hospital re-admission rates or 30-day mortality based on delirium status.
  
  
  CONCLUSIONS
  Delirium occurs in one out of five patients after trans-catheter aortic valve replacement and is associated with diminished survival and increased healthcare utilization. Further studies are needed to clarify whether strategies aimed at reducing delirium after trans-catheter aortic valve replacement may improve outcomes in this high-risk subset. © 2016 Wiley Periodicals, Inc.
authors: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
authors: Chetan P
authors: CP
authors: Huded
authors: Department of Medicine, Case Western Reserve University, Cleveland, Ohio.
authors: Jill M
authors: JM
authors: Huded
authors: Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors: Ranya N
authors: RN
authors: Sweis
authors: Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors: Mark J
authors: MJ
authors: Ricciardi
authors: Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors: S Chris
authors: SC
authors: Malaisrie
authors: Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors: Charles J
authors: CJ
authors: Davidson
authors: Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors: James D
authors: JD
authors: Flaherty
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D016016:Proportional Hazards Models; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000401:mortality; D016896:Treatment Outcome
keywords: aged; aging; aortic valve stenosis; cognition; transcatheter aortic valve intervention