JMIR Publications

ABSTRACT

Background:

Postoperative delirium (POD) is commonly encountered among older surgical patients and is associated with increased healthcare costs. Comprehensive studies focusing on the economic burden of POD in China are lacking, despite the rapid aging of the population.

Objective:

In this study, we assess the economic burden and changes in healthcare costs among older Chinese patients who developed POD and we identify specific cost-driving factors.

Methods:

This retrospective cohort study analyzed perioperative data and included patients aged 65 years or older who underwent abdominal, orthopedic, or other non-neurosurgical and non-cardiac surgeries at The First Medical Center of the Chinese PLA General Hospital between January 2014 and August 2019. Patients who underwent digestive endoscopy or bronchoscopy, those with an American Society of Anesthesiologists physical status classification of grade V, and patients with more than 50% missing perioperative records were excluded. A total of 30,184 patients (mean age 71 years; range 65–104 years) were evaluated. POD was defined and diagnosed based on the criteria stated in the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders. Propensity-score matching (PSM) was used to control for confounding factors related to baseline characteristics and anesthesia surgery variables. The primary outcome variables examined included the total length of hospitalization, the length of postoperative hospitalization, the preoperative length of hospitalization, the total cost of the hospitalization, the cost of drugs, the cost of examinations, and the length of the postoperative intensive care unit stay.

Results:

Among 30,184 patients, 969 (3.2%) were diagnosed with POD. After PSM and compared with POD absence, POD presence was associated with a mean incremental length of hospitalization of 7.2 days (95% confidence interval [CI] 16.60–17.08 days; P < .001), a mean incremental length of postoperative hospitalization of 7.13 days (95% CI 9.65–10.06 days; P < .001), and a mean incremental cost of hospitalization of ¥52787.54 (95% CI ¥86036.79–88782.31; P < .001).

Conclusions:

POD increases healthcare costs and the length of hospitalization for older patients in China, placing a substantial economic burden on the healthcare system. Our findings highlight the importance of preventing and promptly identifying POD in the perioperative management of surgical patients and adjusting healthcare strategies to mitigate the financial impact of POD.