Research on the Risk Factors for Delirium of Stanford Type A Aortic Dissection Patients after Surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

FANGMiao-xuan , XIONGWei-ping , ZENGRong , YUChang-jiang , LIXin ,  FANRui-xin

Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, P.R.China;

Corresponding?author：

FANRui-xin, Email: fangruixin@163.com

Keywords：

Aortic dissection; Cardiac surgery; Postoperative delirium; Risk factors; Multivariate analysis

DOI：

10.7507/1007-4848.20160082

Video：

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Objective To analyze the risk factors for delirium of the Stanford A aortic dissection patients after surgery. Method We retrospectively analyzed the clinical data of 335 patients with type A aortic dissection in Guangdong Cardiac Institution from January 2012 through December 2014. There were 280 males and 55 females. The average of age was 48.5±10.3 years. Delirium status of the patients were evaluated based on confusion assessment method for intensive care unit (CAM-ICU). The patients were divided into two groups including a delirium group and a control group. We tried to find the risk factors for postoperative delirium. Results There were 169 patients of delirium with a incident rate of 50.4%. One-way analysis of variance and multivariate analysis indicated that pre-operative D-dimer level (OR=2.480, 95% CI 1.347-4.564, P<0.01), the minimum mean arterial pressure during operation (OR=0.667, 95% CI 0.612-0.727, P<0.01), the postoperative ventilation time (OR=2.771, 95% CI 1.506-5.101, P<0.01) and the postoperative acute kidney failure (OR=1.911, 95% CI 1.065-3.430, P<0.05) were the independent risk factors for delirium of the Stanford A aortic dissection patient after surgery. Conclusion The incident rate of postoperative delirium of the Standford A aortic dissection patient is relatively high. Patients in this study with elevated pre-operative D-dimer level, lower intraoperative mean arterial pressure, longer postoperative ventilation and combination of acute kidney failure have a higher rate of postoperative delirium. Better understanding and intervention of these factors are meaningful to reduce the occurrence of postoperative delirium.

Citation： FANGMiao-xuan, XIONGWei-ping, ZENGRong, YUChang-jiang, LIXin, FANRui-xin. Research on the Risk Factors for Delirium of Stanford Type A Aortic Dissection Patients after Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(4): 357-361. doi: 10.7507/1007-4848.20160082 Copy

1.	David TE, Maganti M, Armstrong S. Aortic root aneurysm: principles of repair and long-term follow-up. J Thorac Cardiovasc Surg, 2010, 140(6 Suppl): S14-19; discussion： S45-51.
2.	Zhang WY, Wu WL, Gu JJ, et al. Risk factors for postoperative delirium in patients after coronary artery bypass grafting: A prospective cohort study. J Crit Care, 2015, 30(3): 606-612.
3.	Raats JW, van Hoof-de Lepper CC, Feitsma MT, et al. Current factors of fragility and delirium in vascular surgery. Ann Vasc Surg, 2015, 29(5): 968-976.
4.	Inouye SK. Delirium in older persons. N Engl J Med, 2006, 354(11): 1157-1165.
5.	Markar SR, Smith IA, Karthikesalingam A, et al. The clinical and economic costs of delirium after surgical resection for esophageal malignancy. Ann Surg, 2013, 258(1): 77-81.
6.	Etz CD, Di Luozzo G, Bello R, et al. Pulmonary complications after descending thoracic and thoracoabdominal aortic aneurysm repair: predictors, prevention, and treatment. Ann Thorac Surg, 2007, 83(2): S870-876; discussion: S890-892.
7.	Sockalingam S, Parekh N, Bogoch II, et al. Delirium in the postoperative cardiac patient: a review. J Cardiac Surg, 2005, 20(6): 560-567.
8.	Girard TD, Pandharipande PP, Ely EW. Delirium in the intensive care unit. Crit Care, 2008, 12 (Suppl 3): S3.
9.	Trabold B, Metterlein T. Postoperative delirium: risk factors, prevention, and treatment. J Cardiothorac Vascular Anesth, 2014, 28(5): 1352-1360.
10.	Zaal IJ, Devlin JW, Peelen LM, et al. A systematic review of risk factors for delirium in the ICU. Crit Care Med, 2015, 43(1): 40-47.
11.	Sbarouni E, Georgiadou P, Marathias A, et al. D-dimer and BNP levels in acute aortic dissection. Int J Cardiol, 2007, 122(2): 170-172.
12.	Akutsu K, Sato N, Yamamoto T, et al. A rapid bedside D-dimer assay (cardiac D-dimer) for screening of clinically suspected acute aortic dissection. Circ J, 2005, 69(4): 397-403.
13.	Weber T, Rammer M, Auer J, et al. Plasma concentrations of D-dimer predict mortality in acute type A aortic dissection. Heart, 2006, 92(6): 836-837.
14.	Huang B, Yang Y, Lu H, et al. Impact of d-Dimer levels on admission on inhospital and long-term outcome in patients with type A acute aortic dissection. Am J Cardiol, 2015, 115(11): 1595-1600.
15.	Iyano K, Kawada T, Aiba M, et al. Correlation of hemostatic molecular markers and morphology of the residual false lumen in chronic aortic dissection. Ann Thorac Cardiovasc Surg, 2004, 10(2): 106-112.
16.	Wang J, Li Z, Yu Y, et al. Risk factors contributing to postoperative delirium in geriatric patients postorthopedic surgery. Asia Pac Psychiatry, 2015, 7(4): 375-382.
17.	Hirsch J, DePalma G, Tsai TT, et al. Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery dagger. Brit J Anaesth, 2015, 115(3): 418-426.
18.	White H, Venkatesh B. Cerebral perfusion pressure in neurotrauma: a review. Anesth Analg, 2008, 107(3): 979-988.
19.	Numata S, Thomson DS, Seah P, et al. Simplified cerebral protection using unilateral antegrade cerebral perfusion and moderate hypothermic circulatory arrest. Heart Lung Circ, 2009, 18(5): 334-336.
20.	Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA, 2004, 291(14): 1753-1762.
21.	Burkhart CS, Dell-Kuster S, Gamberini M, et al. Modifiable and nonmodifiable risk factors for postoperative delirium after cardiac surgery with cardiopulmonary bypass. J Cardiothorac Vasc Anesth, 2010, 24(4): 555-559.
22.	Lin Y, Chen J, Wang Z. Meta-analysis of factors which influence delirium following cardiac surgery. J Card Surg, 2012, 27(4): 481-492.
23.	Kim WH, Park MH, Kim HJ, et al. Potentially modifiable risk factors for acute kidney injury after surgery on the thoracic aorta: a propensity score matched case-control study. Medicine, 2015, 94(2): e273.
24.	Ko T, Higashitani M, Sato A, et al. Impact of acute kidney injury on early to long-term outcomes in patients who underwent surgery for type A acute aortic dissection. Am J Cardiol, 2015, 116(3): 463-468.
25.	Qiu Z, Chen L, Cao H, et al. Analysis of risk factors for acute kidney injury after ascending aortic replacement combined with open placement of triple-branched stent graft in type A aortic dissection: a new technique versus the traditional method in a single Chinese center. Med Sci Monit, 2015, 21: 674-680.
26.	Roh GU, Lee JW, Nam SB, et al. Incidence and risk factors of acute kidney injury after thoracic aortic surgery for acute dissection. Ann Thorac Surg, 2012, 94(3): 766-771.

1. David TE, Maganti M, Armstrong S. Aortic root aneurysm: principles of repair and long-term follow-up. J Thorac Cardiovasc Surg, 2010, 140(6 Suppl): S14-19; discussion： S45-51.
2. Zhang WY, Wu WL, Gu JJ, et al. Risk factors for postoperative delirium in patients after coronary artery bypass grafting: A prospective cohort study. J Crit Care, 2015, 30(3): 606-612.
3. Raats JW, van Hoof-de Lepper CC, Feitsma MT, et al. Current factors of fragility and delirium in vascular surgery. Ann Vasc Surg, 2015, 29(5): 968-976.
4. Inouye SK. Delirium in older persons. N Engl J Med, 2006, 354(11): 1157-1165.
5. Markar SR, Smith IA, Karthikesalingam A, et al. The clinical and economic costs of delirium after surgical resection for esophageal malignancy. Ann Surg, 2013, 258(1): 77-81.
6. Etz CD, Di Luozzo G, Bello R, et al. Pulmonary complications after descending thoracic and thoracoabdominal aortic aneurysm repair: predictors, prevention, and treatment. Ann Thorac Surg, 2007, 83(2): S870-876; discussion: S890-892.
7. Sockalingam S, Parekh N, Bogoch II, et al. Delirium in the postoperative cardiac patient: a review. J Cardiac Surg, 2005, 20(6): 560-567.
8. Girard TD, Pandharipande PP, Ely EW. Delirium in the intensive care unit. Crit Care, 2008, 12 (Suppl 3): S3.
9. Trabold B, Metterlein T. Postoperative delirium: risk factors, prevention, and treatment. J Cardiothorac Vascular Anesth, 2014, 28(5): 1352-1360.
10. Zaal IJ, Devlin JW, Peelen LM, et al. A systematic review of risk factors for delirium in the ICU. Crit Care Med, 2015, 43(1): 40-47.
11. Sbarouni E, Georgiadou P, Marathias A, et al. D-dimer and BNP levels in acute aortic dissection. Int J Cardiol, 2007, 122(2): 170-172.
12. Akutsu K, Sato N, Yamamoto T, et al. A rapid bedside D-dimer assay (cardiac D-dimer) for screening of clinically suspected acute aortic dissection. Circ J, 2005, 69(4): 397-403.
13. Weber T, Rammer M, Auer J, et al. Plasma concentrations of D-dimer predict mortality in acute type A aortic dissection. Heart, 2006, 92(6): 836-837.
14. Huang B, Yang Y, Lu H, et al. Impact of d-Dimer levels on admission on inhospital and long-term outcome in patients with type A acute aortic dissection. Am J Cardiol, 2015, 115(11): 1595-1600.
15. Iyano K, Kawada T, Aiba M, et al. Correlation of hemostatic molecular markers and morphology of the residual false lumen in chronic aortic dissection. Ann Thorac Cardiovasc Surg, 2004, 10(2): 106-112.
16. Wang J, Li Z, Yu Y, et al. Risk factors contributing to postoperative delirium in geriatric patients postorthopedic surgery. Asia Pac Psychiatry, 2015, 7(4): 375-382.
17. Hirsch J, DePalma G, Tsai TT, et al. Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery dagger. Brit J Anaesth, 2015, 115(3): 418-426.
18. White H, Venkatesh B. Cerebral perfusion pressure in neurotrauma: a review. Anesth Analg, 2008, 107(3): 979-988.
19. Numata S, Thomson DS, Seah P, et al. Simplified cerebral protection using unilateral antegrade cerebral perfusion and moderate hypothermic circulatory arrest. Heart Lung Circ, 2009, 18(5): 334-336.
20. Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA, 2004, 291(14): 1753-1762.
21. Burkhart CS, Dell-Kuster S, Gamberini M, et al. Modifiable and nonmodifiable risk factors for postoperative delirium after cardiac surgery with cardiopulmonary bypass. J Cardiothorac Vasc Anesth, 2010, 24(4): 555-559.
22. Lin Y, Chen J, Wang Z. Meta-analysis of factors which influence delirium following cardiac surgery. J Card Surg, 2012, 27(4): 481-492.
23. Kim WH, Park MH, Kim HJ, et al. Potentially modifiable risk factors for acute kidney injury after surgery on the thoracic aorta: a propensity score matched case-control study. Medicine, 2015, 94(2): e273.
24. Ko T, Higashitani M, Sato A, et al. Impact of acute kidney injury on early to long-term outcomes in patients who underwent surgery for type A acute aortic dissection. Am J Cardiol, 2015, 116(3): 463-468.
25. Qiu Z, Chen L, Cao H, et al. Analysis of risk factors for acute kidney injury after ascending aortic replacement combined with open placement of triple-branched stent graft in type A aortic dissection: a new technique versus the traditional method in a single Chinese center. Med Sci Monit, 2015, 21: 674-680.
26. Roh GU, Lee JW, Nam SB, et al. Incidence and risk factors of acute kidney injury after thoracic aortic surgery for acute dissection. Ann Thorac Surg, 2012, 94(3): 766-771.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Research on the Risk Factors for Delirium of Stanford Type A Aortic Dissection Patients after Surgery

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