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

Abstract

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)

A nomogram model for assessing predictors and prognosis of postoperative delirium in patients receiving acute type A aortic dissection surgery

“…The inclusion criteria were as follows: (1) age > 18 years, (2) documented permission to participate in the research. The exclusion criteria were as follows: (1) history of neurological or psychiatric disorders such as dementia, stroke, schizophrenia, and depression, (2) diagnosis of liver cirrhosis and uremia, (3) suffered from stroke or brain malperfusion prior to MTBSG, (4) suffered from cardiac tamponade-induced presurgical shock or hemodynamic instability, (5) levels of liver enzymes over four times those of baseline, (6) impaired hearing and/or vision, (7) patients who fell into coma after MTBSG, or who died < 24 h of MTBSG, (8) those who received extracorporeal membrane oxygenation therapy.…”

“…Previously, we observed a POD incidence of 37.86% following MTBSG [8]. Among the stand-alone RFs of POD were an acute physiology and chronic health evaluation II (APACHE-II) score > 20, hypoxemia, and other forms of analgesics and sedatives [8]. However, there is limited information on the long-term survival of AAD patients who developed POD after MTBSG.…”

Comparative effectiveness and safety of open triple‐branched stent graft technique with stented elephant trunk implantation in treating Stanford type A aortic dissection: A trial sequential meta‐analysis

“…Approximately 90% of acute Stanford type A AD received various surgical treatments, including fenestration, parallel grafting, and branched stent grafting 8 . However, high incidence of postoperative complications continues to be reported 9 . It remains controversial on the optimal surgical intervention of Stanford type A AD.…”

The catastrophe of hypoxia in complex aortic surgery

“…TBSG implantation was first described by Chen et al 3 in 2010 and is effective in the treatment of type A aortic dissections, however, the procedure, as with most cardiac surgeries is not without risk. Risks associated with this technique include occlusion and disruption of the aorta, paraplegia, and hypoxemia 4,5 …”

“…This is evidenced in a retrospective single‐center study by Wang et al 13 which highlighted the fact that 12.2%−27% of patients undergoing cardiopulmonary bypass experienced postoperative hypoxemia. Failure to consider the neurological status of patients further limits the study, as an observational study by Lin et al 5 concluded that hypoxemia following the insertion of a TBSG increases the risk of postoperative delirium, calling to attention its significance. Still, as mentioned by Wang et al, 6 there exists a scarcity of studies assessing the risk factors of postoperative hypoxemia after TBSG implantation.…”