Risk factors and preventive strategies of postoperative delirium in 209 patients with Stanford B aortic dissection: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Na , WEI Xiang , FENG Xin , CHEN Siqi ,  CHEN Taiqiang

Department of Cardiac and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, P. R. China;

Corresponding author：

CHEN Taiqiang, Email: tqchen@tjh.tjmu.edu.cn

Keywords：

Stanford B aortic dissection; postoperative delirium; risk factor; dexmedetomidine; treatment

DOI：

10.7507/1007-4848.202209033

Video：

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Objective To investigate the risk factors and prevention strategies of postoperative delirium in Stanford B aortic dissection. Methods Clinical data of the patients diagnosed with Stanford B aortic dissection and undergoing endovascular aortic repair from January 2020 to August 2021 in our department were retrospectively collected. Patients were divided into a non-delirium group and a delirium group according to the presence of postoperative delirium. The risk factors for postoperative delirium after Stanford type B aortic dissection and the protective effect of dexmedetomidine on delirium were analyzed. Results A total of 659 patients with Stanford type B aortic dissection were enrolled, including 540 males and 119 females with a median age of 58.00 (41.00, 75.00) years. There were 450 patients in the non-delirium group, and 209 patients in the delirium group. There was no statistical difference in gender, body mass index, hypertension, hyperlipidemia, smoking and drinking history, cholesterol triglyceride level, or creatinine glomerular filtration rate (P＞0.05). Age was an independent risk factor for postoperative delirium in Stanford type B aortic dissection (OR=1.392, 95%CI 1.008-1.923, P=0.044). Moreover, whether dexmedetomidine was used or not had no effect on the duration of postoperative delirium (χ²=4.662, P=0.588). Conclusion Age is an independent risk factor for postoperative delirium in patients with Stanford type B aortic dissection. The incidence of postoperative delirium in young patients is lower than that in the patients with middle and elderly age, and it may be of reference value to prevent postoperative delirium. Dexmedetomidine has no significant effect on controlling the duration of postoperative delirium.

Citation： LI Na, WEI Xiang, FENG Xin, CHEN Siqi, CHEN Taiqiang. Risk factors and preventive strategies of postoperative delirium in 209 patients with Stanford B aortic dissection: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(5): 739-744. doi: 10.7507/1007-4848.202209033 Copy

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5.	朱悦倩, 杨菁, 孙煦, 等. 急性StanfordA型夹层术后谵妄的危险因素分析. 实用医学杂志, 2020, 36(7): 940-943.
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11.	Oldroyd C, Scholz AFM, Hinchliffe RJ, et al. A systematic review and meta-analysis of factors for delirium in vascular surgical patients. J Vasc Surg, 2017, 66(4): 1269-1279.
12.	Lin Y, Chen J, Wang Z. Meta-analysis of factors which influence delirium following cardiac surgery. J Card Surg, 2012, 27(4): 481-492.
13.	肖长波, 王平凡, 张力, 等. 71例急性DebakeyⅠ型主动脉夹层术后神经系统并发症分析. 中国实用神经疾病杂志, 2013, 16(15): 41-43.
14.	Turan A, Duncan A, Leung S, et al. Dexmedetomidine for reduction of atrial fibrillation and delirium after cardiac surgery (DECADE): A randomised placebo-controlled trial. Lancet, 2020, 396(10245): 177-185.
15.	Girard TD, Pandharipande PP, Ely EW. Delirium in the intensive care unit. Crit Care, 2008, 12(Suppl 3): S3.
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17.	Aitken SJ, Blyth FM, Naganathan V. Incidence, prognostic factors and impact of postoperative delirium after major vascular surgery: A meta-analysis and systematic review. Vasc Med, 2017, 22(5): 387-397.
18.	Hirsch J, DePalma G, Tsai TT, et al. Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery. Br J Anaesth, 2015, 115(3): 418-426.
19.	Su X, Meng ZT, Wu XH, et al. Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: A randomised, double-blind, placebo-controlled trial. Lancet, 2016, 388(10054): 1893-1902.
20.	Cortés-Beringola A, Vicent L, Martín-Asenjo R, et al. Diagnosis, prevention, and management of delirium in the intensive cardiac care unit. Am Heart J, 2021, 232: 164-176.

1. Hughes GC. Management of acute type B aortic dissection; ADSORB trial. J Thorac Cardiovasc Surg, 2015, 149(2 Suppl): S158-S162.
2. 侯杨峰, 杨文玲, 范文静, 等. 主动脉夹层发病机制研究的新进展. 心血管病学进展, 2018, 39(5): 847-851.
3. Huang X, Huang L, Sun L, et al. Endovascular repair of Stanford B aortic dissection using two stent grafts with different sizes. J Vasc Surg, 2015, 62(1): 43-48.
4. MacGillivray TE, Gleason TG, Patel HJ, et al. The Society of Thoracic Surgeons/American Association for Thoracic Surgery clinical practice guidelines on the management of type B aortic dissection. Ann Thorac Surg, 2022, 113(4): 1073-1092.
5. 朱悦倩, 杨菁, 孙煦, 等. 急性StanfordA型夹层术后谵妄的危险因素分析. 实用医学杂志, 2020, 36(7): 940-943.
6. Haldenwang PL, Wahlers T, Himmels A, et al. Evaluation of risk factors for transient neurological dysfunction and adverse outcome after repair of acute type A aortic dissection in 122 consecutive patients. Eur J Cardiothorac Surg, 2012, 42(5): e115-e120.
7. Cai S, Zhang X, Pan W, et al. Prevalence, predictors, and early outcomes of post-operative delirium in patients with type A aortic dissection during intensive care unit stay. Front Med(Lausanne), 2020, 7: 572581.
8. Lin YJ, Lin LY, Peng YC, et al. Association between glucose variability and postoperative delirium in acute aortic dissection patients: An observational study. J Cardiothorac Surg, 2021, 16(1): 82.
9. Battle DE. Diagnostic and statistical manual of mental disorders (DSM). Codas, 2013, 25(2): 191-192.
10. 邸龙辉, 荆全民. Stanford B型主动脉夹层治疗新进展. 中国实用内科杂志, 2007, 27(22): 1796-1798.
11. Oldroyd C, Scholz AFM, Hinchliffe RJ, et al. A systematic review and meta-analysis of factors for delirium in vascular surgical patients. J Vasc Surg, 2017, 66(4): 1269-1279.
12. Lin Y, Chen J, Wang Z. Meta-analysis of factors which influence delirium following cardiac surgery. J Card Surg, 2012, 27(4): 481-492.
13. 肖长波, 王平凡, 张力, 等. 71例急性DebakeyⅠ型主动脉夹层术后神经系统并发症分析. 中国实用神经疾病杂志, 2013, 16(15): 41-43.
14. Turan A, Duncan A, Leung S, et al. Dexmedetomidine for reduction of atrial fibrillation and delirium after cardiac surgery (DECADE): A randomised placebo-controlled trial. Lancet, 2020, 396(10245): 177-185.
15. Girard TD, Pandharipande PP, Ely EW. Delirium in the intensive care unit. Crit Care, 2008, 12(Suppl 3): S3.
16. Galyfos GC, Geropapas GE, Sianou A, et al. Risk factors for postoperative delirium in patients undergoing vascular surgery. J Vasc Surg, 2017, 66(3): 937-946.
17. Aitken SJ, Blyth FM, Naganathan V. Incidence, prognostic factors and impact of postoperative delirium after major vascular surgery: A meta-analysis and systematic review. Vasc Med, 2017, 22(5): 387-397.
18. Hirsch J, DePalma G, Tsai TT, et al. Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery. Br J Anaesth, 2015, 115(3): 418-426.
19. Su X, Meng ZT, Wu XH, et al. Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: A randomised, double-blind, placebo-controlled trial. Lancet, 2016, 388(10054): 1893-1902.
20. Cortés-Beringola A, Vicent L, Martín-Asenjo R, et al. Diagnosis, prevention, and management of delirium in the intensive cardiac care unit. Am Heart J, 2021, 232: 164-176.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors and preventive strategies of postoperative delirium in 209 patients with Stanford B aortic dissection: A retrospective cohort study

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