title: Postoperative Delirium After Liver Transplantation is Associated With Increased Length of Stay and Lower Survival in a Prospective Cohort.
abstract: Although postoperative delirium (POD) is a common in-hospital complication associated with negative outcomes, evidence in liver transplantation (LT) is scarce.
  
  
  
  We examined the incidence and duration of POD, its impact on outcomes and health-care utilization, and described predisposing and precipitating factors favoring POD development.
  
  
  
  This prospective cohort study included adults undergoing transplantation in a tertiary hospital. Postoperative delirium was assessed 3 times daily until 24 days post-LT, with the Intensive Care Delirium Screening Checklist on the intensive care unit (ICU) and the Delirium Observation Screening Scale on the ward. Postoperative delirium was noted if any of the daily measurements was positive.
  
  
  
  Forty-two patients (69% male, mean age 55 years, median Model for End-Stage Liver Disease score 15 [interquartile range 8-26]) were included. The incidence of POD was 45.2%, with a median duration of 5 days. Patients with POD had longer ICU (median 8 vs 2 days, P = .000) and hospital stays (median 32 vs 14 days, P = .000) as well as shorter survival (Breslow test P = .045, log-rank test P = .150). Pre-LT comorbidities and perioperative factors might be related to POD development.
  
  
  
  Nurses are key persons in the detection of POD in the daily clinical routine. The high incidence of POD and its negative association with patient outcomes highlight not only the relevance of systematic assessment of POD after LT but also the need for preventive interventions.
authors.affiliation: 1 Institute of Nursing Science, University of Basel, Basel, Switzerland.|2 Department of Abdomen-Metabolism, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Sonja
authors.initials: S
authors.lastname: Beckmann
authors.affiliation: 3 Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland.|4 Directorate of Nursing/MTT, Insel Group AG, University Hospital Insel Bern, Bern, Switzerland.
authors.forename: Maria
authors.initials: M
authors.lastname: Schubert
authors.affiliation: 5 Center for Sleep Medicine, Hirslanden Group, Zollikon, Switzerland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Burkhalter
authors.affiliation: 6 Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Dutkowski
authors.affiliation: 1 Institute of Nursing Science, University of Basel, Basel, Switzerland.|7 Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium.
authors.forename: Sabina
authors.initials: S
authors.lastname: De Geest
mesh_terms: D057189:Checklist; D015897:Comorbidity; D064648:Critical Care Nursing; D003693:Delirium / Q000175:diagnosis* / Q000451:nursing; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009733:Nursing Diagnosis; D011183:Postoperative Complications / Q000175:diagnosis* / Q000451:nursing; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate
keywords: health-care utilization; intensive care unit; mortality; nursing care; postoperative complication