Risk Factors for Postoperative Delirium in Type A Aortic Dissection Patients: A Retrospective Study

Abstract

Background Postoperative delirium (POD) is a common complication in cardiac surgery among adult patients. This retrospective study was designed to identify the risk factors associated with POD of type A aortic dissection patients. Material/Methods Clinical data of 148 patients with type A aortic dissection in the Department of Critical Care Medicine was retrospectively analyzed. All these patients underwent Sun’s procedure with anesthetic treatment. The confusion assessment method for intensive care unit (CAM-ICU) was adapted to evaluate the delirium status of these patients. They were divided into 2 groups: the delirium group and the control group. Univariate analysis and multivariate logistic regression were performed in succession to determine the independent risk factors for POD. Results The average age of these patients was 54.41±11.676 years old. Among the 148 patients, POD was detected in 68 patients, with an incidence of 45.95%. According to univariate analysis, age, irritability, alcohol use, extracorporeal circulation duration (cardiopulmonary bypass, CPB time), antegrade selective cerebral perfusion (ASCP) time, lowest partial pressure of oxygen (lowest PO 2 ), mechanical ventilation time, blood loss, low PO 2 and oxygenation index, hemoglobin (Hb), Intensive Care Unit (ICU) stay, and dihydroxyphenylalanine (DEX) were associated with higher odds of POD among type A aortic dissection patients. According to further analysis of multivariate logistic regression, ASCP time and irritability were confirmed as the independent factors for POD of type A aortic dissection patients. Conclusions We determined 2 independent risk factors for POD: ASCP time and irritability. Identifying and adjusting these risk factors are very important in reducing the incidence of POD among type A aortic dissection patients.

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

“…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.…”

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

“…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. These studies indicated a higher incidence of POD among AAD patients than among other patients.…”

“…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.…”

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

“…In recent years, some studies investigated the incidence of POD in patients with AD after Sun's procedure, which was 32.5-52.0% [10,11]. Their studies found that surgery duration, cardiopulmonary bypass (CPB) time, and selective cerebral perfusion (SCP) time were risk factors for delirium after AD.…”