- Design
- Prospective cohort, single university hospital, 2021–2022
- Population
- 752 adults after major emergency abdominal surgery
- Primary outcome
- Comprehensive Complication Index
- Effect
- Median 44 vs 9 with vs without delirium; 30-day mortality 22% vs 8%
A prospective cohort at one Copenhagen hospital followed 752 patients after major emergency abdominal surgery in 2021–2022, with systematic delirium screening. Delirium developed in 23%.
Those with delirium had far worse courses: a median Comprehensive Complication Index of 44 against 9, a median stay of 13 days against 6, ICU admission in 36% against 13%, more discharges to long-term care, and 30-day mortality of 22% against 8%. Older age, frailty, intraperitoneal contamination and damage-control surgery were risk factors. The rate of complications peaked on the day delirium began.
The timing is the useful part. Delirium in this setting often appears alongside the leak, collection, pneumonia or sepsis that is driving it. A patient who becomes confused on day four after a laparotomy needs a surgical review for a complication, not only haloperidol and a quieter room. This is an observational study and cannot show which comes first in an individual patient, but the clinical response it supports is cheap and low-risk.
- Screen for delirium daily after emergency abdominal surgery, using a tool such as the 4AT or CAM-ICU.
- When new delirium appears, review the patient for anastomotic leak, collection, pneumonia, urinary infection and sepsis that day.
- Check bloods, observations and the drain and wound before attributing confusion to age or environment.
- Identify high-risk patients before surgery — older, frail, contaminated abdomen, damage-control operation — and start prevention measures early.
- Tell families of high-risk patients that confusion is common and is a reason to call the team.
Why it matters
Confusion is often managed as a ward-behaviour problem when it may be the first visible sign of a leak or sepsis.
Don't overread it
This single-centre cohort shows association and timing, not that delirium causes complications or that screening changes outcomes.
The statistics, in plain English
Thirty-day mortality was 22% with delirium against 8% without — nearly three times higher — but sicker patients are both more likely to become delirious and more likely to die, so this difference is not the effect of delirium alone.
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