[Risk factors of delirium after Sun's procedure for acute type A aortic dissection and its influence on patients' prognosis].

Abstract

Objective: To investigate the risk factors of postoperative delirium in Sun's procedure for acute type A aortic dissection and its influence on patients' prognosis. Methods: The clinical data of patients with acute type A aortic dissection who were admitted to Beijing Anzhen Hospital and treated by Sun's procedure from August 2020 to August 2022 were retrospectively collected and analyzed. Patients were divided into delirium group and non-delirium group according to whether postoperative delirium occurred. The mortality rate within 90 days after surgery and the incidences of postoperative complications were compared between the two groups. Multivariate logistic regression was used to analyze the risk factors related to postoperative delirium. Results: A total of 336 patients aged (48.5±10.6) years were enrolled, including 277 males and 59 females. There were 67 patients (19.9%) in the delirium group, of which 18 patients (26.9%) died within 90 days after surgery, which was significantly higher than that in the non-delirium group [26.9% (18/67) vs 7.4% (20/269), P<0.001]. Postoperative length of intensive care unit stay [178 (108, 271) h vs 56 (32, 88) h] and time of mechanical ventilation [105 (36, 197) h vs 17 (12, 41) h] in the delirium group were significantly longer than those in the non-delirium group (both P<0.001). Moreover, the incidences of pneumonia, cardiac shock, respiratory failure, tracheotomy and continuous renal replacement therapy were higher in the delirium group (all P<0.05). Multivariate logistic analysis showed that history of stroke (OR=8.21, 95%CI: 1.86-36.16, P=0.005), preoperative cardiogenic shock (OR=2.61, 95%CI: 1.08-6.33, P=0.033), concomitant left common carotid artery cannulation (OR=2.51, 95%CI: 1.25-5.03, P=0.010) and cardiopulmonary bypss (CPB) time (OR=1.01, 95%CI: 1.01-1.02, P=0.003) were independent risk factors for postoperative delirium. Conclusions: The incidence of postoperative delirium after surgery for type A aortic dissection is high, and the early prognosis of patients with postoperative delirium is poor. History of stroke, preoperative cardiogenic shock, long duration of intraoperative CPB, and intraoperative cerebral perfusion combined with left common carotid artery cannulation are independent risk factors for postoperative delirium.