In-hospital Outcomes Of Patients Undergoing Heart Transplantation With And Without Delirium - Insights From The National Inpatient Sample Database.

Background Delirium is a common complication after undergoing cardiac surgery and is associated with poor outcomes. Limited data is available regarding the incidence and consequences of delirium in patients undergoing heart transplant (HTX). Methods The National Inpatient Sample was queried from 2011-2019 for relevant ICD-9 and ICD-10 codes to identify patients who underwent HTX. Baseline characteristics and in-hospital outcomes between patients with and without delirium were compared. Logistic regression was performed to adjust for pre-specified co-variates for mortality and other in-hospital outcomes. p-value was considered significant when <0.001. Results We identified a weighted sample of 25,371 admissions for HTX, of which 5.8% (n=1,482) had a diagnosis of delirium. Baseline characteristics are shown in Table 1. When controlling for significantly different variables, we found a significantly decreased difference in inpatient mortality in the delirium group (3.7% vs. 5.7%, adjusted OR 0.622 [CI 0.471-0.822], p<0.001). Despite decreased mortality, patients who underwent HTX with concomitant delirium had significantly increased length of stay (aOR 1.004 [CI 1.002-1.006]), post-procedural thromboembolic events (aOR 1.871 [CI 1.648-2.125]), renal replacement therapy use (aOR 2.668 [CI 2.276-3.128]), infections (aOR 1.592 [CI 1.393-1.820]) and HTX rejection (aOR 1.528 [CI 1.289-1.811]), p<0.001 for all. Conclusion While patients undergoing HTX who have a concurrent diagnosis of delirium have lower in-hospital mortality as compared to the non-delirium group, morbidity was significantly higher across multiple indices. Further studies are needed to elucidate the paradoxical effect of delirium on mortality and characterize the risks of delirium in this patient population. Delirium is a common complication after undergoing cardiac surgery and is associated with poor outcomes. Limited data is available regarding the incidence and consequences of delirium in patients undergoing heart transplant (HTX). The National Inpatient Sample was queried from 2011-2019 for relevant ICD-9 and ICD-10 codes to identify patients who underwent HTX. Baseline characteristics and in-hospital outcomes between patients with and without delirium were compared. Logistic regression was performed to adjust for pre-specified co-variates for mortality and other in-hospital outcomes. p-value was considered significant when <0.001. We identified a weighted sample of 25,371 admissions for HTX, of which 5.8% (n=1,482) had a diagnosis of delirium. Baseline characteristics are shown in Table 1. When controlling for significantly different variables, we found a significantly decreased difference in inpatient mortality in the delirium group (3.7% vs. 5.7%, adjusted OR 0.622 [CI 0.471-0.822], p<0.001). Despite decreased mortality, patients who underwent HTX with concomitant delirium had significantly increased length of stay (aOR 1.004 [CI 1.002-1.006]), post-procedural thromboembolic events (aOR 1.871 [CI 1.648-2.125]), renal replacement therapy use (aOR 2.668 [CI 2.276-3.128]), infections (aOR 1.592 [CI 1.393-1.820]) and HTX rejection (aOR 1.528 [CI 1.289-1.811]), p<0.001 for all. While patients undergoing HTX who have a concurrent diagnosis of delirium have lower in-hospital mortality as compared to the non-delirium group, morbidity was significantly higher across multiple indices. Further studies are needed to elucidate the paradoxical effect of delirium on mortality and characterize the risks of delirium in this patient population.