Incidence and Risk Factors of Delirium in Patients After Type-A Aortic Dissection Surgery

Liu, Zhengqin; Pang, Xinyan; Zhang, Xiquan; Cao, Guangqing; Fang, Changcun; Wu, Shanshan

doi:10.1053/j.jvca.2016.11.011

Cited by 27 publications

(42 citation statements)

References 16 publications

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“…However, none of our studies found that operative time and CPB time had an effect on POD. Shi et al [10] and Liu et al [11] found that the surgical methods were all Sun's surgery, and this study was a three-branch stent surgery. By comparison, the operation time of delirium group was 288.5 (250.8, 334.3) and that of the non-delirium group was 285.0 (249.5, 333.0), which was 200 minutes shorter than those of Shi et al [10] and Liu et al [11] and the CPB time was 40-100 minutes shorter.…”

Section: Discussionmentioning

confidence: 85%

Risk factors for postoperative delirium in patients with triple-branched stent graft implantation

Lin

Chen

Zhang

et al. 2020

Preprint

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Background: Neurological complications is a common complication following novel triple-branched stent graft implantation in patients with Stanford type A aortic dissection (AAD). But the incidence and risk factors of postoperative delirium (POD) are not completely clear. The aim of this study was to investigate the incidence and risk factors of POD after novel triple-branched stent graft implantation.Methods: An observational study of AAD patients who underwent novel triple-branched stent graft implantation between January 2017 and July 2019 were followed up after surgery. Patients’ delirium was screened by the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the intensive care unit from the first day after the operation, lasted 5 days. The risk factors of POD were analyzed by the Cox proportional hazard models.Results: A total of 280 AAD patients were enrolled in this research, the incidence of POD was 37.86%. Adjusting for age, body mass index, and mechanical ventilation duration, multivariate Cox regression analysis model revealed that non-manual work (adjusted hazard ratio [AHR] = .554; 95% CI: 0.335-0.915; P = .021), Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores > 20 (AHR = 3.359, 95% CI: 1.707-6.609, P < .001), hypoxemia (AHR = 1.846, 95% CI: 1.118-3.048, P = .017), and more than two types of analgesics and sedatives were independently associated with POD.Conclusions: This study showed that risk factors independently associated with POD were APACHE-II score > 20, hypoxemia, and more types of analgesics and sedatives, and non-manual work was the protective factor.Trial registration: This study was retrospectively registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR1900022408; Date: 2019/4/10)

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Section: Discussionmentioning

confidence: 85%

Risk factors for postoperative delirium in patients with triple-branched stent graft implantation

Lin

Chen

Zhang

et al. 2020

Preprint

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“…Gaul et al found that POD is the most common neurological complication in patients with AAD, accounting for 31.9% of all neurological complication events (10). Liu et al (14) also reported that the incidence of POD in 100 AAD patients reached 34%. Shi et al (15) stated an incidence of 45.95% in 148 AAD patients.…”

Section: Discussionmentioning

confidence: 96%

“…The rule of thumb in logistic modeling is that a minimum of ten events per predictor variable should be achieved based on simulation studies (19). We used the lowest incidence 34% (14) and ten valuables in logistic model to estimate the sample size of 294.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have demonstrated a high prevalence of POD among these patients and raised concerns about delirium prevention in this population. However, the risk factors reported was diverse, and these studies are limited by small sample size (10,14,15). Due to the particularity of disease and surgery, the characteristics of POD in AAD patients might be quite different from other patients of cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence, Predictors, and Early Outcomes of Post-operative Delirium in Patients With Type A Aortic Dissection During Intensive Care Unit Stay

et al. 2020

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The aim of this study was to investigate the prevalence and explore the predictors and early outcomes of post-operative delirium (POD) in patients with type A aortic dissection (AAD) during intensive care unit (ICU) stays. Methods: We retrospectively reviewed the records of 301 patients with AAD who underwent surgical treatment in our institution from January 2017 to December 2018. Results: Delirium developed in 73 patients (24.25%) during the ICU stay. Patients with lower estimated glomerular filtration rates [odds ratio (OR) 0.84, 95% CI 0.74-0.94, p = 0.003], post-operative midazolam use (OR 2.37, 95% CI 1.33-4.23, p = 0.004), and post-operative morphine use (OR 1.87, 95% CI 1.07-3.29, p = 0.029) were more susceptible to developing POD. Patients who developed POD had a longer ICU stay (11.52 vs. 7.22 days, p < 0.001) and hospital stay (23.99 vs. 18.91, p = 0.007) with higher hospitalization costs (48.82 vs. 37.66 thousand dollars, p < 0.001) than those without POD. The in-hospital mortality rate was higher in the delirium group, but the difference was not significant (6.85 vs. 4.82%, p = 0.502). Conclusions: The incidence of POD in patients with AAD was high and was associated with renal dysfunction and the use of midazolam and morphine. POD was associated with poor early outcomes, suggesting the importance of early screening, such as for renal dysfunction, and prevention by using sedation scales to minimize the use of midazolam and morphine in these patients.

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“…By comparison, the operation time of delirium group was 288. 5 (250.8, 334.3) and that of non-delirium group was 285.0 (249.5, 333.0), which was 200 minutes shorter than those of Shi et al [10] and Liu et al [11] and the CPB time was 40-100 minutes shorter.…”

Section: Discussionmentioning

confidence: 65%

Risk factors for postoperative delirium in patients with triple-branched stent graft implantation

Lin

Chen

Zhang

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The incidence of neurological complications is relatively high after novel triple-branched stent graft implantation in patients with Stanford type A aortic dissection (AAD). But the incidence and risk factors of postoperative delirium (POD) have not been studied. The aim of this study was to investigated the incidence and risk factors of POD after novel triple-branched stent graft implantation.Methods: An observational study of AAD patients who underwent novel triple-branched stent graft implantation between January 2017 and July 2019 was followed up after surgery. Patients’ delirium is screened by the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the intensive care unit from the first day after the operation, lasted 5 days. The risk factors of POD was analyzed by the Cox proportional hazard models.Results: A total of 280 cases of AAD patients were enrolled in this research, the incidence of POD was 37.86%. Adjusting for age, body mass index, and mechanical ventilation duration, multivariate Cox regression analysis model revealed that non-manual work (adjusted hazard ratio [AHR] = .554; 95% CI: 0.335-0.915; P = .021), Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores > 20 (AHR = 3.359, 95% CI: 1.707-6.609, P < .001), hypoxemia (AHR = 1.846, 95% CI: 1.118-3.048, P = .017), and more than two types of analgesics and sedatives were independently associated with POD.Conclusions: This study showed that risk factors independently associated with POD were APACHE-II score > 20, hypoxemia and more types of analgesics and sedatives, and non-manual work was the protective factor.Trial registration: This study was retrospectively registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR1900022408; Date: 2019/4/10)

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Incidence and Risk Factors of Delirium in Patients After Type-A Aortic Dissection Surgery

Cited by 27 publications

References 16 publications

Risk factors for postoperative delirium in patients with triple-branched stent graft implantation

Risk factors for postoperative delirium in patients with triple-branched stent graft implantation

Prevalence, Predictors, and Early Outcomes of Post-operative Delirium in Patients With Type A Aortic Dissection During Intensive Care Unit Stay

Risk factors for postoperative delirium in patients with triple-branched stent graft implantation

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