In-hospital coded prevalence and associated factors of postoperative delirium following rotator cuff repair surgery: a retrospective national inpatient sample database study

BACKGROUND: While postoperative delirium (POD) is a well-known postoperative complication, research on its incidence and risk factors in rotator cuff repair surgeries lacks a robust analysis using a comprehensive national dataset. METHODS: Leveraging the National Inpatient Sample (NIS), the most extensive all-payer hospital database in the U.S., we performed a retrospective cohort study analyzing 7,216 patients who underwent rotator cuff repair from 2016 to 2019. Our assessment included patient demographics, hospital-related variables, comorbid conditions, and postoperative adverse events to identify key associations. RESULTS: Among patients undergoing inpatient rotator cuff repair between 2016 and 2019, the in-hospital coded prevalence of POD was 7.5%, with the highest rate (8.8%) recorded in 2019. Patients who developed POD following rotator cuff repair surgery demonstrated several adverse outcomes, including advanced age, increased comorbidity burden, prolonged hospital stays, and higher hospitalization costs (p < 0.001). They were also more prone to experiencing various perioperative medical and surgical complications during their hospitalization. These complications encompassed urinary tract infections, pneumonia, acute renal failure, septicemia, thrombocytopenia, blood transfusions, acute cerebrovascular events, peripheral vascular disease, urinary retention, and other medical concerns. Surgical complications, such as hemorrhage, seroma, or hematoma, were also observed. Multiple factors were associated with POD, including advanced age (65 years or older), Medicaid or private insurance coverage, alcohol or drug abuse, deficiency anemias, neurological disorders, and psychoses. On the other hand, being female and having an elective hospital admission reduced the risk of developing POD. CONCLUSION: Among patients undergoing inpatient rotator cuff repair, POD had an in-hospital coded prevalence of 7.5%-a non-negligible proportion. Studying its contributing factors remains important, and recognizing these risks may help clinicians refine treatment approaches and enhance patient recovery. These findings are not generalizable to outpatient rotator cuff repair procedures.