Incidence, Predictors and Outcomes of Delirium in Complicated Type B Aortic Dissection Patients After Thoracic Endovascular Aortic Repair

• Main Authors: Liu J, Yang F, Luo S, Li C, Liu W, Liu Y, Huang W, Xie E, Chen L, Su S, Yang X, Geng Q, Luo J
• Format: Article
• Language: English
• Published: Dove Medical Press 2021-08-01
• Series: Clinical Interventions in Aging
• Subjects: type b aortic dissection; thoracic endovascular aortic repair; hybrid procedure; postoperative delirium; predictors; outcomes.
• Online Access: https://www.dovepress.com/incidence-predictors-and-outcomes-of-delirium-in-complicated-type-b-ao-peer-reviewed-fulltext-article-CIA

Jitao Liu,1,&ast; Fan Yang,2,&ast; Songyuan Luo,1,&ast; Chenxi Li,3 Weijie Liu,4 Yuan Liu,1 Wenhui Huang,1 Enmin Xie,5 Lyufan Chen,6 Sheng Su,5 Xinyue Yang,6 Qingshan Geng,1 Jianfang Luo1,5 1Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China; 2Department of Emergency and Critical Care Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China; 3Department of Cardiac Surgery Intensive Care Unit, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China; 4Center for Information Technology and Statistics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China; 5The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People’s Republic of China; 6School of Medicine, South China University of Technology, Guangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jianfang Luo; Qingshan GengDepartment of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, #106 Zhongshan Second Road, Yuexiu District, Guangzhou, Guangdong, 510080, People’s Republic of ChinaTel [phone]Fax + 86-20-83875453Email [e-mail]; [e-mail]: The present study aimed to investigate the incidence and predictors of post-operative delirium (POD) in patients with complicated type B aortic dissection (TBAD) undergoing TEVAR with/without concomitant procedures and to assess the association of POD with early and follow-up outcomes.Methods: A retrospective single-center cross-sectional analysis was conducted using a prospectively maintained database from 2010 to 2017. Outcomes were postoperative clinical outcomes, early and follow-up survival.Results: A total of 517 complicated TBAD patients were enrolled. POD was observed in 13.3% (69/517) patients and was associated with increased hospital length of stay (LOS) and hospital costs (P< 0.001 for both). Besides, POD was found to be an independent risk factor for prolonged ICU stay (odds ratio [OR] 4.39, 95% confidence interval [CI] 2.40– 8.01, P< 0.001) and early death (OR 4.42, 95% CI 1.26– 15.54, P= 0.020). Predictors of POD were hybrid procedure (OR 2.17, 95% CI 1.20– 3.92, P= 0.010), the use of benzodiazepine (OR 1.86, 95% CI 1.07– 3.23, P= 0.027) or quinolone (OR 2.35, 95% CI 1.26– 4.38, P= 0.007), creatinine > 2 mg/dL (OR 3.25, 95% CI 1.57– 6.72, P= 0.001) and preoperative blood transfusion (OR 3.31, 95% CI 1.76– 6.21, P< 0.001). After a median follow-up of 73.6 months, POD remained as an independent indicator for follow-up mortality (hazard ratio [HR] 2.40, 95% CI 1.31– 4.38, P= 0.005) after adjusting potential confounders.Conclusion: POD after TEVAR has an incidence of around 13% and could profoundly increase the in-hospital LOS, hospital costs, as well as the early and follow-up mortality. A series of risk factors, including hybrid procedure, the use of benzodiazepine or quinolone, creatinine > 2 mg/dL and preoperative blood transfusion, were identified as independent risk factors for POD. Effective risk-stratification and patient-tailored management strategy should be developed to reduce the incidence of POD.Keywords: type B aortic dissection, thoracic endovascular aortic repair, hybrid procedure, postoperative delirium, predictors, outcomes