000			03116nam a22003617a 4500
008			180619s20182018 xxu||||| |||| 00| 0 eng d
022			_a1078-1439
024			_a10.1016/j.urolonc.2018.04.012 [doi]
024			_aS1078-1439(18)30134-0 [pii]
040			_aOvid MEDLINE(R)
099			_a29801992
245			_aA contemporary population-based analysis of the incidence, cost, and outcomes of postoperative delirium following major urologic cancer surgeries.
251			_aUrologic Oncology. 2018 May 22
252			_aUROL. ONCOL.. 2018 May 22
253			_aUrologic oncology
260			_c2018
260			_fFY2018
266			_d2018-06-19
520			_aCONCLUSIONS: Patients with PD after urologic cancer surgeries experienced worse outcomes, prolonged LOS, and increased admission costs. The greatest incidence and costs were seen after RC. Further research is warranted to identify high-risk patients and devise preventative strategies.
520			_aCopyright (c) 2018 Elsevier Inc. All rights reserved.
520			_aMATERIALS AND METHODS: We performed a population-based, retrospective cohort study of patients with PD at 490 US hospitals between 2003 and 2013 to evaluate the incidence, outcomes, and cost of delirium after radical prostatectomy, radical nephrectomy, partial nephrectomy, and radical cystectomy (RC). Delirium was defined using ICD-9 codes in combination with postoperative antipsychotics, sitters, and restraints. Regression models were constructed to assess mortality, discharge disposition, length of stay (LOS), and direct hospital admission costs. Survey-weighted adjustment for hospital clustering achieved estimates generalizable to the US population.
520			_aPURPOSE: Postoperative delirium (PD) is associated with poor outcomes and increased health care costs. The incidence, outcomes, and cost of delirium for major urologic cancer surgeries have not been previously characterized in a population-based analysis.
520			_aRESULTS: We identified 165,387 patients representing a weighted total of 1,097,355 patients. The overall incidence of PD was 2.7%, with the greatest incidence occurring after RC, with 6,268 cases (11%). Delirious patients had greater adjusted odds of in-hospital mortality (odds ratio [OR] = 3.65, P<0.001), 90-day mortality (OR = 1.47, P = 0.013), discharge with home health services (OR = 2.25, P<0.001), discharge to skilled nursing facilities (OR = 4.64, P<0.001), and a 0.9-day increase in median LOS (P<0.001). Patients with delirium also experienced a _2,697 increase in direct admission costs (P<0.001), with the greatest costs incurred in RC patients ( _30,859 vs. _26,607; P<0.001).
546			_aEnglish
650			_aIN PROCESS -- NOT YET INDEXED
651			_aMedStar Washington Hospital Center
656			_aNeurology
657			_aJournal Article
700			_aKrasnow, Ross E
790			_aChang SL, Ha A, Hshieh TT, Krasnow RE, Mossanen M, Nagle R, Rudolph JL
856			_uhttps://dx.doi.org/10.1016/j.urolonc.2018.04.012 _zhttps://dx.doi.org/10.1016/j.urolonc.2018.04.012
942			_cART _dArticle
999			_c3374 _d3374