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The Clinical and Economic Costs of Delirium After Surgical Resection for Esophageal Malignancy

Markar, Sheraz R. MRCS(Eng), MA(cantab)*; Smith, Ian A. MD; Karthikesalingam, Alan MRCS(Eng), MSc, MA(cantab)*; Low, Donald E. FACS, FRCS*

doi: 10.1097/SLA.0b013e31828545c1
Original Articles

Objective: The aim of this study was to identify preoperative risk factors and postoperative consequences that are associated with the occurrence of delirium after esophagectomy for malignancy.

Background: Delirium is an underdiagnosed, serious complication after major surgery, particularly in the elderly population.

Methods: All patients undergoing esophagectomy for cancer (1991–2011) were included. Patients with and without delirium were compared with respect to medical comorbidities, use of neoadjuvant therapy, operative outcomes, postoperative complications, overall cost, and survival.

Results: Of the 500 patients included in this analysis, 46 (9.2%) patients developed postoperative delirium. Patients with delirium had higher ASA and Charlson comorbidity index scores. Delirium was associated with a longer hospital (14 ± 7.5 vs 10.9 ± 5.7; P < 0.05) and intensive care unit stay (3.6 ± 3.8 vs 2.7 ± 16.9; P < 0.05) and an increased incidence of pulmonary complications and increased hospital costs. Delirium was preceded by another complication in 32.6% of cases but by a septic complication in only 19.6% of cases. Age was the only preoperative predictor of postoperative delirium in multivariate modeling (P < 0.05). No differences were noted in the use of neoadjuvant chemoradiotherapy or survival.

Conclusions: This study demonstrates that postoperative delirium is associated with a more complicated and costly recovery after esophagectomy and that age is independently predictive of its development. Delirium has often been thought to be the sequela of other complications; however, this study demonstrates that it presents in isolation or precedes other complications in 67.4% of cases. Focused screening will likely allow targeted preventative strategies to be used in the perioperative period to reduce complications and costs associated with delirium.

Of 500 patients analyzed in this study, 46 (9.2%) were affected by postoperative delirium and had an increased length of hospital and intensive care unit stay, incidence of pulmonary complications, and hospital costs. This study demonstrates that delirium presents in isolation or precedes other complications in 67.4% of cases.

Departments of *Thoracic Surgery

Pulmonary and Critical Care Medicine, Virginia Mason Medical Center, Seattle, WA.

Reprints: Donald E. Low, FACS, FRCS, Department of Thoracic Surgery, Virginia Mason Medical Center, 1100 Ninth Ave, Seattle, WA 98111. E-mail:

Poster presentation at Digestive Disease Week 2012.

Supported in part by the Ryan Hill Research Foundation.

Disclosure: The authors declare no conflicts of interest.

© 2013 by Lippincott Williams & Wilkins.