Clinical Investigation
Risk factors for postoperative delirium in patients after Stanford A aortic dissection surgery: a prospective cohort study
Song Xianrong, Cheng Zhaoyun, Liu Furong, Ding Fuyan
Published 2016-10-25
Cite as Chin J Thorac Cardiovasc Surg, 2016, 32(10): 607-611. DOI: 10.3760/cma.j.issn.1001-4497.2016.10.007
Abstract
ObjectiveThis study aims to analyze the independent risk factors associated with postoperative delirium of patients undergoing Stanford A aortic dissection surgery.
MethodsClinical data of the patients who underwent Stanford A aortic dissection surgery from December 2014 to October 2015 were collected. All patients received surgery under deep hypothermic circulatory arrest (DHCA) and the nasal temperature goal was below 23℃. After surgery, patients were transferred to the cardiovascular ICU, where they received standard postoperative care. The delirium was diagnosed according to the criteria of the confusion assessment method for the intensive care unit (CAM-ICU) . The possible risk factors of pre-operation, during operation or post-operation were analyzed via univariate analysis and multivariate logistic regression to determine the independent risk factorsof postoperative delirium.
Results148 patients underwent Stanford A aortic dissection surgery which the incidence of postoperative delirium was 31.1% (46/148) . Univariate analysis showed the associated risk factors were age, hypertension, cognitive impairment, emergency operation, operation time, aorta clamping time, DHCA time, fluctuation of blood pressure during operation, blood transfusion, quality of sleep, length of ICU stay and electrolyte disturbance (P <0.05) . Multivariate logistic regression analysis revealed that hypertension, cognitive impairment, fluctuation of mean arterial blood pressure (MAP) >30 mmHg (1 mmHg= 0.133 kPa) , DHCA time > 40 min, postoperative poor quality of sleep and electrolyte disturbance were independently associated with postoperative delirium after Stanford A aortic dissection surgery ( P < 0.05) .
ConclusionDelirium is a frequent complication. Factors independently associated with delirium are hypertension, cognitive impairment, DHCA time, postoperative poor quality of sleep and electrolyte disturbance. Prevent, assess and manage delirium should be paid more attention and reinforced.
Key words:
Stanford A aortic dissection; Postoperative delirium; Incidence; Risk factors
Contributor Information
Song Xianrong
Department of Cardiovascular Surgey ICU, He'nan Provincial Thoracic Hospital, Zhengzhou 450008, China
Cheng Zhaoyun
Department of Cardiovascular Surgey, He'nan Provincial People's Hospital, Zhengzhou 450003, China
Liu Furong
Department of Cardiovascular Surgey, He'nan Provincial People's Hospital, Zhengzhou 450003, China
Ding Fuyan
Department of Cardiovascular Surgey, He'nan Provincial People's Hospital, Zhengzhou 450003, China
