Introduction: Delirium is increasingly being recognized as a major complication following surgery and has significant impact on recovery and postoperative morbidity. While prior studies have examined delirium rates in the medical or surgical ICU, there are limited reports looking at delirium specifically within neurosurgical patients. We examined the prevalence of delirium, associated risk factors, and associated outcomes in patients undergoing a cranial neurosurgical procedure.
Methods: 235 consecutive adult patients who underwent a cranial surgery were retrospectively analyzed. As part of routine clinical care, delirium screening was performed during each patient’s hospital course using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) or Nursing Delirium Screening Scale (NuDESC) questionnaires. Patient, treatment, and outcome characteristics were determined from clinical reports available through the electronic medical record.
Results: 52 patients (22.1%) within the cohort screened positive for delirium at least once during their hospital stay. On bivariate analysis, patient characteristics associated with delirium included older age, race/ethnicity (African American and Asian), pathologic diagnosis (hydrocephalus, infection, and vascular lesions), and admission as a transfer or through the emergency room. Hospitalization characteristics associated with delirium included longer ICU length of stay, abnormal sodium, a postoperative infection, and a new neurological deficit postoperatively. On multivariate logistic regression analysis, older age, longer length of ICU stay, and the presence of a neurological deficit were all significantly associated with delirium. Compared to patients who did not screen positive, patients with delirium had significantly longer lengths of admission (16 vs. 4 days) and were less likely to discharge home (32.69% vs. 89.62%).
Conclusions: Delirium is prevalent in patients requiring neurosurgery and is associated with several patient and hospitalization characteristics. These results may help identify patients on a neurosurgical service who are at-risk for delirium in order to enact delirium precautions and interventions pre-emptively.
Patient Care: These results may help identify patients on a neurosurgical service who are at-risk for delirium in order to enact delirium precautions and interventions pre-emptively.
Learning Objectives: 1. Describe the prevalence of delirium in a general neurosurgical patient cohort
2. Highlight associated patient and hospitalization factors that are associated with delirium
3. Highlight outcomes associated with the occurrence of delirium while hospitalized