The following is a summary of the “A retrospective analysis of the incidence of postoperative delirium and the importance of database selection for its definition,” published in the February 2023 issue of Psychiatry by Yang, et al.

Negative effects from postoperative delirium (POD) are not uncommon following major surgery. Nevertheless, a large-scale national database is needed to investigate the incidence and risk variables linked with POD after shoulder arthroplasty (SA). Therefore, the biggest fully funded hospital care database in the United States, the Nationwide Inpatient Sample (NIS), was used in a retrospective database analysis spanning 2005-2014. These patients were all undergoing SA. They looked at the patient’s age, gender, diagnoses, length of hospital stay (LOS), total cost, insurance coverage, hospital, in-hospital mortality rate, and complication rates from both the operating room and the medical ward.

The NIS database yielded a total of 115,147 SA patients. A peak incidence of 0.89% of patients experiencing delirium following SA was seen in that year. Compared to patients without delirium after SA, those with it had more co-morbidities, longer LOS, higher hospitalization expenses, and a higher in-hospital death rate (P<0.0001). Acute renal failure, acute myocardial infarction, pneumonia, pulmonary embolism, stroke, urinary tract infection, septic shock, continuous invasive mechanical ventilation, blood transfusions, and other perioperative problems were linked to these patients’ hospital stays. 

Factors that increase the likelihood of POD include advancing age, neurological disease, depression, psychosis, fluid and electrolyte abnormalities, and renal failure. 

Having the option to go to the hospital and having private health insurance are protective factors. After SA, delirium occurs in a small percentage of patients. Increased co-morbidities, length of stay (LOS), total expenses (including those not covered by Medicare), mortality, and perioperative complications were all linked to delirium after SA. The proper management and mitigation of POD’s effects can be ensured by studying risk factors. While this study helped to improve preoperative optimization and management, it also revealed some limitations of this type of research and the need to establish a country-based POD database. These included clearly defining the diagnostic criteria for POD, investigating risk factors, and collecting data after discharge (30 days or more).

Source: bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-023-04576-4