Direct Costs of Care Associated With Postoperative Delirium in Cirrhotic Patients Undergoing First Orthotopic Liver Transplantation

Abstract

Objective

To analyze the direct costs of care associated with postoperative delirium (POD) in cirrhotic patients undergoing first orthotopic liver transplantation (OLT) in a Hospital in Antioquia, Colombia, 2013–2021.

Methods

A retrospective registry-based follow-up study of cirrhotic patients, 14 or older, who underwent their first OLT. POD, diagnosed and registered by the psychiatrist, and other clinical variables were retrieved from the medical history. The direct cost of care was estimated from administrative records and is expressed in 2020 international dollars (I$) using the purchase power parity of I$ 1 = COP 1,352.786. Differences in cost were estimated with the Generalized Linear Model.

Results

One hundred and sixty-one patients followed for 2,718 days (16.9 days on average) were included; 24.4% of them presented POD for a rate of 1.43 cases per 100 person-days. Among patients who did not present POD, the adjusted mean cost of care was I$92,981 (95% CI: 86,691-99,271) compared to an adjusted mean cost of I$122,187 (95% CI: 103,152–141,222) among cases of POD; the adjusted mean difference was I$29,206 (95% CI: 9,846–48,565). The higher cost among POD patients was most likely explained by an increased length of stay (mean difference = 5.6 days, 95% CI: 2.6–8.6).

Conclusion

POD is a frequent post-OLT complication among cirrhotic patients and is associated with an increased length of stay that impacts the direct cost of care. Prevention of POD may aid in reducing the medical and economic burden of post-OLT complications.