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

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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, lymphocyte percentage, operative duration, intubation time, and ICU stay might 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 operative and intubation times are associated with a higher risk of delirium in patients undergoing TEVAR, while no significant association was found in patients undergoing EVAR.

1.	中国医师协会心血管外科分会大血管外科专业委员会. 急性主动脉综合征诊断与治疗规范中国专家共识(2021版). 中华胸心血管外科杂志, 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.	舒畅, 施俊哲, 葛建军, 等. 杂交技术治疗累及弓部主动脉病变的中国专家共识. 中国循环杂志, 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.
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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.
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7.	梅伟, 刘尚昆, 张治国, 等. 中文版护理谵妄筛查量表的信度和效度研究. 中华护理杂志, 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.	张静, 兰星, 陈庆红, 等. 护士参与麻醉门诊术前教育对麻醉恢复期患者的影响. 护理学杂志, 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, 郭东英, 谭心娟, 等. 基于线性拟合法对危重症患者血压与谵妄关系的研究. 中国卫生统计, 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.	刘佳丽, 赵昱东, 朱明双. 老年髋部骨折患者术后谵妄危险因素的Meta分析. 中医临床研究, 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.	张雨嫣, 付琴, 刁文杰, 等. 胸主动脉杂交手术的配合体会. 中华全科医学, 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.	张帅, 陈娟红, 富燕萍, 等. 应用集束化措施降低主动脉夹层患者术后谵妄的护理实践. 中华急危重症护理杂志, 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.	汤铂, 王小亭, 陈文劲, 等. 重症患者谵妄管理专家共识. 中华内科杂志, 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. 中国医师协会心血管外科分会大血管外科专业委员会. 急性主动脉综合征诊断与治疗规范中国专家共识(2021版). 中华胸心血管外科杂志, 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. 舒畅, 施俊哲, 葛建军, 等. 杂交技术治疗累及弓部主动脉病变的中国专家共识. 中国循环杂志, 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. 梅伟, 刘尚昆, 张治国, 等. 中文版护理谵妄筛查量表的信度和效度研究. 中华护理杂志, 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. 张静, 兰星, 陈庆红, 等. 护士参与麻醉门诊术前教育对麻醉恢复期患者的影响. 护理学杂志, 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, 郭东英, 谭心娟, 等. 基于线性拟合法对危重症患者血压与谵妄关系的研究. 中国卫生统计, 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. 刘佳丽, 赵昱东, 朱明双. 老年髋部骨折患者术后谵妄危险因素的Meta分析. 中医临床研究, 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. 张雨嫣, 付琴, 刁文杰, 等. 胸主动脉杂交手术的配合体会. 中华全科医学, 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. 张帅, 陈娟红, 富燕萍, 等. 应用集束化措施降低主动脉夹层患者术后谵妄的护理实践. 中华急危重症护理杂志, 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. 汤铂, 王小亭, 陈文劲, 等. 重症患者谵妄管理专家共识. 中华内科杂志, 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.

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