Abstract: PD14-08
Sources of Funding: None

Introduction

Post-operative delirium is associated with poor outcomes and increased healthcare costs in the elderly. A population-based analysis of incidence, outcomes, and cost of delirium has not been characterized in major urologic cancer surgeries.

Methods

Using the Premier Hospital Database, we retrospectively identified patients who had undergone radical prostatectomy (RP), radical nephrectomy (RN), partial nephrectomy (PN), and radical cystectomy (RC) from 2003 to 2013. Delirium was defined using International Classification of Disease, Ninth-Revision (ICD-9) codes, as well as post-operative use of antipsychotics, sitters, and restraints. We constructed regression models to assess for mortality, discharge disposition, length of stay (LOS), and direct hospital costs. Survey-weighted adjustment for hospital clustering was used to achieve estimates generalizable to the US population.

Results

We identified 165,387 patients representing a weighted total of 1,097,355 patients from 490 hospitals. 30,063 (2.7%) experienced post-operative delirium. The greatest incidence occurred after RC, with 6,268 cases (11%). After adjusting for patient, hospital, and peri-operative characteristics, patients with post-operative delirium had greater odds of in-hospital mortality (OR 3.65; 95% CI 2.56-5.22; p <0.001), 90-day mortality (OR 1.47; 95% CI 1.08-1.99; p = 0.013), discharge with home healthcare (OR 2.25; 95% CI 1.94-2.61; p <0.001), discharge to skilled nursing facilities (OR 4.64; 95% CI, 3.93-5.48; p <0.001), and an increase in median LOS by 0.9 days (95% CI 0.84-0.96; p <0.001). Patients with post-operative delirium also had an increase in direct hospital costs by $2,697 (95% CI, $2,250-$3,144; p <0.001). When stratified by type of surgery, the greatest difference in cost was seen in patients following RC ($30,859 vs. $26,607; p<0.001). The largest driver of costs was in room and board across all surgeries (p<0.001).

Conclusions

Patients with post-operative delirium experience worse outcomes, prolonged LOS, and increased admission costs following major urologic cancer surgeries. In particular, the largest incidence and costs occurred in delirious patients after RC. Further research is warranted in order to identify high-risk patients and devise preventive strategies.

Funding

None