Analysis of influencing factors of postoperative delirium after endovascular aortic repair: A case-control study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIONG Yi , GAO Chuan , MU Chunfang , ZHAO Xuemei , LI Yuanfei , LI Chunyue ,  HU Kejian

Department of Nursing, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding?author：

HU Kejian, Email: 17379014@qq.com

Keywords：

Endovascular aortic repair; postoperative delirium; influencing factors; case-control study

DOI：

10.7507/1007-4848.202309053

Video：

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Objective To analyze the influencing factors of delirium after endovascular aortic repair, and to provide a basis for clinical nursing and prevention of this condition. Methods Patients who underwent endovascular aortic repair at Fuwai Hospital, Chinese Academy of Medical Sciences from 2018 to 2019 were selected. The Chinese version of the Nursing Delirium Screening Scale (Nu-DESC) was used to assess whether postoperative delirium occurred. Patients with a Nu-DESC score≥ 3 were assigned to the delirium group. Non-delirium patients who had the same surgeon and adjacent surgical order were selected at a 1 : 4 ratio to form the non-delirium group. Univariate analysis was performed on the clinical data of the two groups. Factors with P<0.1 in the univariate analysis and those considered clinically significant were included in a multivariate logistic regression analysis to identify the influencing factors of postoperative delirium. Stratified analysis was conducted based on thoracic endovascular aortic repair (TEVAR) and endovascular abdominal aortic repair (EVAR). Results A total of 213 patients were included, comprising 46 in the delirium group and 167 in the non-delirium group. The overall mean age was (60.3±12.0) years, and 183 (85.9%) were male. Univariate analysis showed that emergency admission, preoperative neutrophil percentage, aortic dissection, surgical duration, intubation time, and ICU stay may be associated with postoperative delirium. Multivariate analysis revealed that longer operative and intubation times were associated with a higher likelihood of delirium. In the stratified analysis, the results for the TEVAR group were consistent with the overall findings, whereas no significant differences were observed in the EVAR group. Conclusion Longer surgical and intubation times are associated with an increased risk of delirium in patients undergoing TEVAR. No significant factors influencing delirium are identified in patients undergoing EVAR.

Citation： XIONG Yi, GAO Chuan, MU Chunfang, ZHAO Xuemei, LI Yuanfei, LI Chunyue, HU Kejian. Analysis of influencing factors of postoperative delirium after endovascular aortic repair: A case-control study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(10): 1462-1466. doi: 10.7507/1007-4848.202309053 Copy

1.	中國醫師協會心血管外科分會大血管外科專業委員會. 急性主動脈綜合征診斷與治療規范中國專家共識(2021版). 中華胸心血管外科雜志, 2021, 37(5): 257-269.Committee of Great Vessels of Chinese Association of Cardiovascular Surgeons. Chinese experts' consensus of standardized diagnosis and treatment for acute aortic syndrome (2021). Chin J Clin Thorac Cardiovasc Surg, 2021, 37(5): 257-269.
2.	舒暢, 施俊哲, 葛建軍, 等. 雜交技術治療累及弓部主動脈病變的中國專家共識. 中國循環雜志, 2020, 35(2): 124-129.Shu C, Shi JZ, Ge JJ, et al. Chinese expert consensus on hybrid technique on treating thoracic aortic pathologies involving the aortic arch. Chin J Circ, 2020, 35(2): 124-129.
3.	Liu J, Yang F, Luo S, et al. Incidence, predictors and outcomes of delirium in complicated type B aortic dissection patients after thoracic endovascular aortic repair. Clin Interv Aging, 2021, 16: 1581-1589.
4.	Salata K, Katznelson R, Beattie WS, et al. Endovascular versus open approach to aortic aneurysm repair surgery: rates of postoperative delirium. Can J Anaesth, 2012, 59(6): 556-561.
5.	Aldecoa C, Bettelli G, Bilotta F, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol, 2017, 34(4): 192-214.
6.	Gaudreau JD, Gagnon P, Harel F, et al. Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale. J Pain Symptom Manage, 2005, 29(4): 368-375.
7.	梅偉, 劉尚昆, 張治國, 等. 中文版護理譫妄篩查量表的信度和效度研究. 中華護理雜志, 2010, 45(2): 101-104.Mei W, Liu SK, Zhang ZG, et al. The validity and reliability of the Chinese version of Nursing Delirium Screening Scale. Chin J Nurs, 2010, 45(2): 101-104.
8.	Mu DL, Wang DX, Li LH, et al. High serum cortisol level is associated with increased risk of delirium after coronary artery bypass graft surgery: a prospective cohort study. Crit Care, 2010, 14(6): R238.
9.	Rudolph JL, Jones RN, Grande LJ, et al. Impaired executive function is associated with delirium after coronary artery bypass graft surgery. J Am Geriatr Soc, 2006, 54(6): 937-941.
10.	張靜, 蘭星, 陳慶紅, 等. 護士參與麻醉門診術前教育對麻醉恢復期患者的影響. 護理學雜志, 2020, 35(2): 56-58.Zhang J, Lan X, Chen QH, et al. Effect of nurses participating in preoperative health education in anesthesia clinic on patients in recovery period. J Nurs Sci, 2020, 35(2): 56-58.
11.	李惠萍, 郭東英, 譚心娟, 等. 基于線性擬合法對危重癥患者血壓與譫妄關系的研究. 中國衛生統計, 2022, 39(2): 207-209, 214.Li HP, Guo YD, Tan XJ, et al. Relationship between blood pressure and delirium in critically ill patients. Chin J Health Stat, 2022, 39(2): 207-209, 214.
12.	劉佳麗, 趙昱東, 朱明雙. 老年髖部骨折患者術后譫妄危險因素的Meta分析. 中醫臨床研究, 2022, 14(9): 111-115.Liu JL, Zhao YD, Zhu MS, et al. Meta-analysis of risk factors for postoperative delirium in elderly patients with hip fracture. Clin J Chin Med, 2022, 14(9): 111-115.
13.	張雨嫣, 付琴, 刁文杰, 等. 胸主動脈雜交手術的配合體會. 中華全科醫學, 2022, 20(11): 1978-1981.Zhang YY, Fu Q, Diao WJ, et al. Experience in coordination in thoracic aortic hybrid surgery. Chin J Gen Pract, 2022, 20(11): 1978-1981.
14.	Peng C, Wang M, Geng Y, et al. Risk factors for postoperative delirium in ICU patients with severe illness based on systematic review and meta-analysis. Ann Palliat Med, 2022, 11(1): 309-320.
15.	張帥, 陳娟紅, 富燕萍, 等. 應用集束化措施降低主動脈夾層患者術后譫妄的護理實踐. 中華急危重癥護理雜志, 2020, 1(4): 328-331.Zhang S, Chen JH, Fu YP, et al. The nursing practice of applying bundling measures in reducing postoperative delirium in aortic dissection patients. Chin J Emerg Crit Care Nurs, 2020, 1(4): 328-331.
16.	湯鉑, 王小亭, 陳文勁, 等. 重癥患者譫妄管理專家共識. 中華內科雜志, 2019, 58(2): 108-118.Tang B, Wang XT, Chen WJ, et al. Experts consensus on the management of delirium in critically ill patients. Chin J Intern Med, 2019, 58(2): 108-118.

1. 中國醫師協會心血管外科分會大血管外科專業委員會. 急性主動脈綜合征診斷與治療規范中國專家共識(2021版). 中華胸心血管外科雜志, 2021, 37(5): 257-269.Committee of Great Vessels of Chinese Association of Cardiovascular Surgeons. Chinese experts' consensus of standardized diagnosis and treatment for acute aortic syndrome (2021). Chin J Clin Thorac Cardiovasc Surg, 2021, 37(5): 257-269.
2. 舒暢, 施俊哲, 葛建軍, 等. 雜交技術治療累及弓部主動脈病變的中國專家共識. 中國循環雜志, 2020, 35(2): 124-129.Shu C, Shi JZ, Ge JJ, et al. Chinese expert consensus on hybrid technique on treating thoracic aortic pathologies involving the aortic arch. Chin J Circ, 2020, 35(2): 124-129.
3. Liu J, Yang F, Luo S, et al. Incidence, predictors and outcomes of delirium in complicated type B aortic dissection patients after thoracic endovascular aortic repair. Clin Interv Aging, 2021, 16: 1581-1589.
4. Salata K, Katznelson R, Beattie WS, et al. Endovascular versus open approach to aortic aneurysm repair surgery: rates of postoperative delirium. Can J Anaesth, 2012, 59(6): 556-561.
5. Aldecoa C, Bettelli G, Bilotta F, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol, 2017, 34(4): 192-214.
6. Gaudreau JD, Gagnon P, Harel F, et al. Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale. J Pain Symptom Manage, 2005, 29(4): 368-375.
7. 梅偉, 劉尚昆, 張治國, 等. 中文版護理譫妄篩查量表的信度和效度研究. 中華護理雜志, 2010, 45(2): 101-104.Mei W, Liu SK, Zhang ZG, et al. The validity and reliability of the Chinese version of Nursing Delirium Screening Scale. Chin J Nurs, 2010, 45(2): 101-104.
8. Mu DL, Wang DX, Li LH, et al. High serum cortisol level is associated with increased risk of delirium after coronary artery bypass graft surgery: a prospective cohort study. Crit Care, 2010, 14(6): R238.
9. Rudolph JL, Jones RN, Grande LJ, et al. Impaired executive function is associated with delirium after coronary artery bypass graft surgery. J Am Geriatr Soc, 2006, 54(6): 937-941.
10. 張靜, 蘭星, 陳慶紅, 等. 護士參與麻醉門診術前教育對麻醉恢復期患者的影響. 護理學雜志, 2020, 35(2): 56-58.Zhang J, Lan X, Chen QH, et al. Effect of nurses participating in preoperative health education in anesthesia clinic on patients in recovery period. J Nurs Sci, 2020, 35(2): 56-58.
11. 李惠萍, 郭東英, 譚心娟, 等. 基于線性擬合法對危重癥患者血壓與譫妄關系的研究. 中國衛生統計, 2022, 39(2): 207-209, 214.Li HP, Guo YD, Tan XJ, et al. Relationship between blood pressure and delirium in critically ill patients. Chin J Health Stat, 2022, 39(2): 207-209, 214.
12. 劉佳麗, 趙昱東, 朱明雙. 老年髖部骨折患者術后譫妄危險因素的Meta分析. 中醫臨床研究, 2022, 14(9): 111-115.Liu JL, Zhao YD, Zhu MS, et al. Meta-analysis of risk factors for postoperative delirium in elderly patients with hip fracture. Clin J Chin Med, 2022, 14(9): 111-115.
13. 張雨嫣, 付琴, 刁文杰, 等. 胸主動脈雜交手術的配合體會. 中華全科醫學, 2022, 20(11): 1978-1981.Zhang YY, Fu Q, Diao WJ, et al. Experience in coordination in thoracic aortic hybrid surgery. Chin J Gen Pract, 2022, 20(11): 1978-1981.
14. Peng C, Wang M, Geng Y, et al. Risk factors for postoperative delirium in ICU patients with severe illness based on systematic review and meta-analysis. Ann Palliat Med, 2022, 11(1): 309-320.
15. 張帥, 陳娟紅, 富燕萍, 等. 應用集束化措施降低主動脈夾層患者術后譫妄的護理實踐. 中華急危重癥護理雜志, 2020, 1(4): 328-331.Zhang S, Chen JH, Fu YP, et al. The nursing practice of applying bundling measures in reducing postoperative delirium in aortic dissection patients. Chin J Emerg Crit Care Nurs, 2020, 1(4): 328-331.
16. 湯鉑, 王小亭, 陳文勁, 等. 重癥患者譫妄管理專家共識. 中華內科雜志, 2019, 58(2): 108-118.Tang B, Wang XT, Chen WJ, et al. Experts consensus on the management of delirium in critically ill patients. Chin J Intern Med, 2019, 58(2): 108-118.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis of influencing factors of postoperative delirium after endovascular aortic repair: A case-control study

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