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Original Research |

Outcomes Associated With Delirium in Older Patients in Surgical ICUs

Michele C. Balas, PhD, RN, CCRN*; Mary Beth Happ, PhD, RN; Wei Yang, PhD; Lakshmipathi Chelluri, MD, MPH, FCCP; Therese Richmond, PhD, CRNP
Author and Funding Information

*From the University of Pennsylvania School of Nursing (Drs. Balas and Richmond), Philadelphia; University of Pittsburgh School of Nursing and Center for Bioethics and Health Law (Dr. Happ), Pittsburgh; Department of Biostatistics and Epidemiology (Dr. Yang), University of Pennsylvania School of Medicine, Philadelphia; and Department of Critical Care Medicine (Dr. Chelluri), University of Pittsburgh School of Medicine, Pittsburgh, PA.

Correspondence to: Michele C. Balas, PhD, RN, CCRN; e-mail: balasm@nursing.upenn.edu

*Data are presented as mean ± SD or No. (%).

†Assistive devices included canes/crutches, walkers, wheelchairs, or shower seats.

‡Katz ADL > 5 means independent in five or more ADL.

§General surgery category includes colorectal, surgical oncology, and GI surgical services.

‖Other category includes otorhinolaryngology, oral/maxillofacial, urology, gynecology/oncology, orthopedics, and plastic surgical services.

*Data are presented as No. (%) or mean ± SD.

†Preadmission living conditions and HHC/personal assistant use calculated on 110 subjects reporting being admitted from home; discharge living conditions and HHC use calculated on 74 subjects reporting being discharged home.

‡The range of scores for the Katz ADL is 0 (dependent in all ADL) to 6 (independent in all ADL).

*General surgery category includes colorectal, surgical oncology, and GI surgical services.

†Other category includes otorhinolaryngology, oral/maxillofacial, urology, gynecology/oncology, orthopedics, and plastic surgical services.

‡The type and number of SICU complications in the study population included cardiac arrhythmias (n = 19), pneumonia (n = 7), reintubation (n = 7), urinary tract infection (n = 6), acute renal failure (n = 6), GI bleeding (n = 6), deep vein thrombosis (n = 5), myocardial infarction (n = 4), suspected adverse drug event (n = 4), sepsis (n = 3), pulmonary emboli (n = 3), cerebral vascular accident (n = 2), and cardiopulmonary resuscitation (n = 1).

*C statistic for discharge placement model = 0.83; C statistic for functional ability model = 0.81.

†General surgery category includes colorectal, surgical oncology, and GI surgical services.

‡Other category includes otorhinolaryngology, oral/maxillofacial, urology, gynecology/oncology, orthopedics, and plastic surgical services.

§The type and number of SICU complications in the study population included cardiac arrhythmias (n = 19), pneumonia (n = 7), reintubation (n = 7), urinary tract infection (n = 6), acute renal failure (n = 6), GI bleeding (n = 6), deep vein thrombosis (n = 5), myocardial infarction (n = 4), suspected adverse drug event (n = 4), sepsis (n = 3), pulmonary emboli (n = 3), cerebral vascular accident (n = 2), cardiopulmonary resuscitation (n = 1).

The study was conducted at the Hospital of the University of Pennsylvania, Philadelphia, PA.

This research was supported in part by a Building Academic Geriatric Nursing Capacity Hartford-Atlantic Postdoctoral Fellowship.

The authors have no conflicts of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


The study was conducted at the Hospital of the University of Pennsylvania, Philadelphia, PA.

The study was conducted at the Hospital of the University of Pennsylvania, Philadelphia, PA.

This research was supported in part by a Building Academic Geriatric Nursing Capacity Hartford-Atlantic Postdoctoral Fellowship.

This research was supported in part by a Building Academic Geriatric Nursing Capacity Hartford-Atlantic Postdoctoral Fellowship.

The authors have no conflicts of interest to disclose.

The authors have no conflicts of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(1):18-25. doi:10.1378/chest.08-1456
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Background:  We previously noted that older adults admitted to surgical ICUs (SICUs) are at high risk for delirium. In the current study, we describe the association between the presence of delirium and complications in older SICU patients, and describe the association between delirium occurring in the SICU and functional ability and discharge placement for older patients.

Methods:  Secondary analysis of prospective, observational, cohort study. Subjects were 114 consecutive patients ≥ 65 years old admitted to a surgical critical care service. All subjects underwent daily delirium and sedation/agitation screening during hospitalization. Outcomes prospectively recorded included SICU complication development, discharge location, and functional ability (as measured by the Katz activities of daily living instrument).

Results:  Nearly one third of older adults (31.6%) admitted to an SICU had a complication during ICU stay. There was a strong association between SICU delirium and complication occurrence (p = 0.001). Complication occurrence preceded delirium diagnosis for 16 of 20 subjects. Subjects with delirium in the SICU were more likely to be discharged to a place other than home (61.3% vs 20.5%, p < 0.0001) and have greater functional decline (67.7% vs 43.6%, p = 0.023) than nondelirious subjects. After adjusting for covariates including severity of illness and mechanical ventilation use, delirium was found to be strongly and independently associated with greater odds of being discharged to a place other than home (odds ratio, 7.20; 95% confidence interval, 1.93 to 26.82).

Conclusions:  Delirium in older surgical ICU patients is associated with complications and an increased likelihood of discharge to a place other than home.

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