Doubts about treating hypogonadism due to long-term opioid use with testosterone therapy: a teachable moment.

than 14 days of corticosteroid use3; thus, administration of steroids should not be delayed while awaiting biopsy. For our patient, temporal artery biopsy could have been performed as an outpatient procedure, especially given her high risk for developing delirium as an inpatient. Her age, multiple comorbidities, and history of delirium increased her vulnerability to recurrent delirium. A hospital setting exposes patients to polypharmacy, disruption of sleep/wake cycles, and tethers such as intravenous catheters and telemetry, and as many as 11% to 14% of medical patients outside of an intensive care unit develop delirium during their hospitalizations.4 Delirium leads to longer lengths of stay and higher in-hospital mortality and is associated with an increased rate of death, institutionalization, and development of dementia.5 These risks are independent of comorbid illness and baseline dementia, indicating that an episode of delirium itself may have permanent deleterious effects on the brain. Choosing to hospitalize this patient for a procedure that could have been performed as an outpatient resulted in a prolonged hospital course and the development of delirium, putting her at risk for further adverse outcomes. Hospitalization also inflicted substantial financial burdens and emotional stress on the patient and her family. This case should prompt physicians to consider the risks of hospitalization carefully when deciding on the best setting for a patient’s workup or procedure.