Hospital costs of post-operative delirium: A systematic review

Aims: In this systematic review, the primary aim is to investigate the hospital cost burden attributed to post-operative delirium (POD). A secondary aim is to examine how patient length of stay (LOS) in hospital varies across the selected studies. Background: POD is a common occurrence after major surgery and leads to serious medical complications. It is associated with increased morbidity and double the risk of mortality from surgery compared to non-delirious patients. POD increases patient LOS in hospital and increases the economic burden on patients and the health system. Design: A systematic review was conducted. Method: Published articles in English over the period 2010 to 2020 were searched using the PubMed and MEDLINE databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The study quality and risks of bias of included studies were assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). Results: A total of 2539 published records were initially screened and ultimately ten studies were found to be relevant to the review criteria. Six studies were from the United States of America (USA) and the others from South Korea, Australia, and Canada. The additional costs for patients with POD ranged from a minimum of US$1551 to a maximum of US$23 698 compared to non-delirious patients. Costs were higher in the USA than other countries. Studies reported most surgical patients experiencing POD were aged 70 years or older which dramatically increases the risk of its occurrence and increases LOS and hospital related costs. The difference in LOS between POD and nondelirious patients ranged from 0.8 to 7.3 days and this increased significantly if POD patients were in intensive care. Conclusions: Increased LOS and increased hospital costs are strongly associated with POD after major surgery.