Delirium after emergency laparotomy coincides with the peak of complications

Design

Prospective single-centre cohort

Population

752 adults after major emergency abdominal surgery in Denmark

Primary outcome

Comprehensive Complication Index

Effect

Delirium in 23%; CCI median 44 vs 9; 30-day mortality 22% vs 8%

This prospective Danish cohort followed 752 patients after major emergency abdominal surgery in 2021 to 2022, with systematic delirium screening.

Delirium developed in 175 (23%). It was associated with a higher Comprehensive Complication Index (median 44 vs 9), longer stay (13 vs 6 days), more ICU admission (36% vs 13%) and higher 30-day mortality (22% vs 8%). Risk factors were older age, frailty, intraperitoneal contamination and damage-control surgery. Complications clustered around delirium onset: the rate was highest on the day delirium began (0.72 events per patient-day) and roughly halved afterwards.

The timing is the useful part. New confusion after an emergency laparotomy is often treated as a nursing or geriatric problem to be managed with a sedative. Here it travelled with the day of highest complication rate, so it should prompt a surgical search for a cause. The study cannot say whether delirium causes complications or signals them; either way, it is a reason to examine the patient.

• Treat new delirium after emergency abdominal surgery as a trigger for full surgical review, including abdomen, wound and bloods.
• Screen daily with a validated tool in older, frail patients and after contamination or damage-control surgery.
• Look for sepsis, leak, hypoxia, urinary retention and drug causes before reaching for sedation.
• Discuss the raised risk of long-term care discharge with families early for those who become delirious.

Why it matters

Delirium is often filed as a ward-management issue when it may be the first sign of a surgical complication.

Don't overread it

This is observational; it shows complications and delirium coincide, not which causes which.

The statistics, in plain English

An incidence rate ratio of 0.49 means complications occurred at about half the rate after delirium onset compared with the period just before it — so the peak sits around onset. The mortality and stay differences are unadjusted comparisons and partly reflect how sick the delirious patients already were.

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