Ökonomische Bedeutung des postoperativen Delirs bei älteren Patienten nach Elektivoperationen aus Perspektive der Krankenhäuser – Ergebnisse der PAWEL – Studie

Zusammenfassung

Zielsetzung

Ziel war die Ermittlung der ökonomischen Bedeutung des postoperativen Delirs (POD) bei älteren Patienten nach Elektivoperationen aus Krankenhaus-Perspektive.

Methodik

Die Abrechnungsdaten von in der PAWEL-Studie rekrutierten Patienten (Alter ≧ 70 Jahre) aus zwei Studienzentren wurden analysiert. Die inkrementellen Kosten und Erlöse des PODs wurden mit einem generalisierten linearen Modell (GLM) geschätzt. Mit einer logistischen Regression wurde untersucht, ob das POD ein signifikanter Prädiktor einer Unterdeckung ist.

Ergebnisse

Daten von 538 älteren Patienten bei elektiven größeren Operationen konnten analysiert werden (POD: 120, non-POD: 418). Die inkrementellen stationären Kosten je POD wurden im GLM auf 6870 € geschätzt, die Erlöse auf 5769 €. Das POD ist ein signifikanter Prädiktor einer Unterdeckung.

Schlussfolgerung

Das Vorliegen eines PODs zeigt einen deutlichen, ökonomischen Effekt für die Krankenhäuser.

Abstract

Aim

The study aimed to determine the economic impact of postoperative delirium (POD) in elderly patients after elective surgery from a hospital perspective.

Method

Claims data of older patients (aged ≧ 70 years) recruited in the PAWEL study from two study centers were analyzed. Incremental costs and revenues per POD were estimated using a generalized linear model (GLM). Logistic regression was used to examine whether POD is a significant predictor of shortfall.

Results

Data of 538 patients could be analyzed (POD: 120, non-POD: 418). Incremental costs per POD were estimated at € 6,870 in the GLM, and revenues at € 5,769. The occurrence of a POD is a significant predictor of shortfall.

Conclusion

POD in older patients shows a substantial economic effect for the hospitals.

Schlüsselwörter

elektive Operationen - postoperatives Delir - Kosten

Keywords

elective surgery - postoperative delirium - costs

• Literatur

• 1 Aldecoa C, Bettelli G, Bilotta F. et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol 2017; 34: 192-214
• 2 Whitlock EL, Vannucci A, Avidan MS. Postoperative delirium. Minerva Anestesiol 2011; 77: 448-456
• 3 Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet 2014; 383: 911-922
• 4 Guenther U, Riedel L, Radtke FM. Patients prone for postoperative delirium: preoperative assessment, perioperative prophylaxis, postoperative treatment. Curr Opin Anaesthesiol 2016; 29: 384-390
• 5 Fong TG, Tulebaev SR, Inouye SK. Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol 2009; 5: 210-220
• 6 Dasgupta M, Dumbrell AC. Preoperative risk assessment for delirium after noncardiac surgery: a systematic review. J Am Geriatr Soc 2006; 54: 1578-1589
• 7 Zoremba N, Coburn M. Acute Confusional States in Hospital. Dtsch Arztebl Int 2019; 116: 101-106
• 8 Hshieh TT, Yue J, Oh E. et al. Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis. JAMA Intern Med 2015; 175: 512-520
• 9 Deeken F, Sanchez A, Rapp MA. et al. Outcomes of a Delirium Prevention Program in Older Persons After Elective Surgery: A Stepped-Wedge Cluster Randomized Clinical Trial. JAMA Surg 2021; e216370 doi:10.1001/jamasurg.2021.6370
• 10 Pretto M, Spirig R, Milisen K. et al. Effects of an interdisciplinary nurse-led Delirium Prevention and Management Program (DPMP) on nursing workload: a pilot study. Int J Nurs Stud 2009; 46: 804-812
• 11 Rizk P, Morris W, Oladeji P. et al. Review of Postoperative Delirium in Geriatric Patients Undergoing Hip Surgery. Geriatr Orthop Surg Rehabil 2016; 7: 100-105
• 12 Caplan GA, Teodorczuk A, Streatfeild J. et al. The financial and social costs of delirium. Eur Geriatr Med 2020; 11: 105-112
• 13 Zywiel MG, Hurley RT, Perruccio AV. et al. Health economic implications of perioperative delirium in older patients after surgery for a fragility hip fracture. J Bone Joint Surg Am 2015; 97: 829-836
• 14 Brown CHT, Laflam A, Max L. et al. The Impact of Delirium After Cardiac Surgical Procedures on Postoperative Resource Use. Ann Thorac Surg 2016; 101: 1663-1669
• 15 Guenther U, Koegl F, Theuerkauf N. et al. Nursing workload indices TISS-10, TISS-28, and NEMS : Higher workload with agitation and delirium is not reflected. Med Klin Intensivmed Notfmed 2016; 111: 57-64
• 16 Markar SR, Smith IA, Karthikesalingam A. et al. The clinical and economic costs of delirium after surgical resection for esophageal malignancy. Ann Surg 2013; 258: 77-81
• 17 Ha A, Krasnow RE, Mossanen M. et al. A contemporary population-based analysis of the incidence, cost, and outcomes of postoperative delirium following major urologic cancer surgeries. Urol Oncol 2018; 36: 341 e315-341 e322
• 18 Milbrandt EB, Deppen S, Harrison PL. et al. Costs associated with delirium in mechanically ventilated patients. Crit Care Med 2004; 32: 955-962
• 19 Sanchez A, Thomas C, Deeken F. et al. Patient safety, cost-effectiveness, and quality of life: reduction of delirium risk and postoperative cognitive dysfunction after elective procedures in older adults-study protocol for a stepped-wedge cluster randomized trial (PAWEL Study). Trials 2019; 20: 71
• 20 Thomas C, Kreisel SH, Oster P. et al. Diagnosing delirium in older hospitalized adults with dementia: adapting the confusion assessment method to international classification of diseases, tenth revision, diagnostic criteria. J Am Geriatr Soc 2012; 60: 1471-1477
• 21 Inouye SK, Leo-Summers L, Zhang Y. et al. A chart-based method for identification of delirium: validation compared with interviewer ratings using the confusion assessment method. J Am Geriatr Soc 2005; 53: 312-318
• 22 World Health Organization. International Statistical Classification of Diseases and Related Health Problems (ICD). In. 2021
• 23 Park R. Estimation with Heteroscedastic Error Terms. Econometrica 1966; 34: 888
• 24 Deb P, Norton EC. Modeling Health Care Expenditures and Use. Annu Rev Public Health 2018; 39: 489-505
• 25 Masnoon N, Shakib S, Kalisch-Ellett L. et al. What is polypharmacy? A systematic review of definitions. BMC Geriatr 2017; 17: 230
• 26 van Lieshout C, Schuit E, Hermes C. et al. Hospitalisation costs and health related quality of life in delirious patients: a scoping review. Z Evid Fortbild Qual Gesundhwes 2022; 169: 28-38
• 27 Weinrebe W, Johannsdottir E, Karaman M. et al. What does delirium cost? An economic evaluation of hyperactive delirium. Z Gerontol Geriatr 2016; 49: 52-58
• 28 Barber J, Thompson S. Multiple regression of cost data: use of generalised linear models. J Health Serv Res Policy 2004; 9: 197-204