Abstract
Background: Postoperative delirium (POD), an alteration in a patient's consciousness pattern, can affect the treatment and prognosis of a disease.Objective: To construct a prediction model for delirium in patients with type A aortic dissection after surgery and to validate its effectiveness.Methods: A retrospective cohort design was used to study 438 patients undergoing surgical treatment for type A aortic dissection from April 2019 to June 2020 in tertiary care hospitals. POD (n = 78) and non-delirium groups (n = 360) were compared and analyzed for each index in the perioperative period. A prediction model was established using multifactorial logistic regression, and 30 patients' perioperative data were collected for model validation.Results: Eight predictors were included in this study: smoking, diabetes, previous cardiovascular surgery, ejection fraction (EF), time to aortic block, acute kidney injury, low cardiac output syndrome, and pulmonary complications. The area under the receiver operating characteristic (ROC) curve of the constructed prediction model was 0.98 ± 0.005, and the Youden index was 0.91. The validation results showed 97% sensitivity, 100% specificity, and 93% accuracy. The expression of the model was Z = Smoking assignment* – 2.807 – 6.009*Diabetes assignment – 2.994*Previous cardiovascular surgery assignment – 0.129*Ejection fraction assignment + 0.071*Brain perfusion time assignment – 2.583*Acute kidney injury assignment – 2.916*Low cardiac output syndrome assignment – 3.461*Pulmonary related complications assignment + 20.576.Conclusion: The construction of an effective prediction model for the risk of delirium in patients after type A aortic stratification can help identify patients at high risk of POD early. It also provides a reference for healthcare professionals in the prevention and care of these patients.
Highlights
Postoperative delirium (POD), an alteration in a patient’s consciousness pattern, can affect the treatment and prognosis of a disease
Patients in the delirium group were analyzed for risk factors associated with the non-delirium group, and the results showed statistically significant differences (p < 0.05) in smoking, diabetes, previous cardiovascular surgery, ejection fraction (EF), EuroScore II, circulatory arrest time, cardio-pulmonary bypass (CPB) time, cross-clamp time, postoperative/cryoprecipitation, acute kidney injury, low cardiac output syndrome, and pulmonary complications (Table 1)
The statistically significant variables in the univariate analysis were included in the multivariate analysis, and the results showed that smoking, diabetes, previous cardiovascular surgery, EF, aortic block time, acute kidney injury, low cardiac output syndrome, and pulmonary complications independently influenced POD (p < 0.05) (Table 2)
Summary
Postoperative delirium (POD), an alteration in a patient’s consciousness pattern, can affect the treatment and prognosis of a disease. Aortic dissection (AD) is caused by the tearing of the intimal layer of the aorta or bleeding within the aortic wall, where blood flows between the layers of the aortic wall, separating the layers of the same (entrapment) [1] It is a common condition associated with high mortality [2]. The occurrence of POD prolongs the total length of hospital stay, increases intensive care unit (ICU) morbidity and mortality two to fourfold [13], and significantly increases the level of care dependency in patients who develop POD after discharge [14]. We investigated the risk factors for POD in patients with aortic dissection and constructed a prediction model to predict such risks
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