Abstract
Objectives: The aim of this study was to investigate the prevalence and explore the predictors and early outcomes of post-operative delirium (POD) in patients with type A aortic dissection (AAD) during intensive care unit (ICU) stays.Methods: We retrospectively reviewed the records of 301 patients with AAD who underwent surgical treatment in our institution from January 2017 to December 2018.Results: Delirium developed in 73 patients (24.25%) during the ICU stay. Patients with lower estimated glomerular filtration rates [odds ratio (OR) 0.84, 95% CI 0.74–0.94, p = 0.003], post-operative midazolam use (OR 2.37, 95% CI 1.33–4.23, p = 0.004), and post-operative morphine use (OR 1.87, 95% CI 1.07–3.29, p = 0.029) were more susceptible to developing POD. Patients who developed POD had a longer ICU stay (11.52 vs. 7.22 days, p < 0.001) and hospital stay (23.99 vs. 18.91, p = 0.007) with higher hospitalization costs (48.82 vs. 37.66 thousand dollars, p < 0.001) than those without POD. The in-hospital mortality rate was higher in the delirium group, but the difference was not significant (6.85 vs. 4.82%, p = 0.502).Conclusions: The incidence of POD in patients with AAD was high and was associated with renal dysfunction and the use of midazolam and morphine. POD was associated with poor early outcomes, suggesting the importance of early screening, such as for renal dysfunction, and prevention by using sedation scales to minimize the use of midazolam and morphine in these patients.
Highlights
Post-operative delirium (POD) is common in patients undergoing elective cardiac surgery, including aortic valve replacement and coronary artery bypass grafting (CABG)
A total of 365 cases have been reviewed and after exclusion 34 patients who did not receive surgery, seven patients who presented with pre-operative delirium or had chronic schizophrenia, 17 patients with incomplete data to identify POD, and six patients with incomplete risk factor data
The patients were divided into two groups according to whether they developed POD during the intensive care units (ICUs) stay
Summary
Post-operative delirium (POD) is common in patients undergoing elective cardiac surgery, including aortic valve replacement and coronary artery bypass grafting (CABG). Type A aortic dissection (AAD) is a lifethreatening condition requiring surgical intervention [5, 6]. As both the disease itself and intraoperative deep hypothermic circulatory arrest might cause ischemia to the cerebral circulation and nervous system, patients with AAD might have a greater risk of developing neuropsychiatric complications than patients undergoing other cardiac surgeries [7, 8]. Due to the stress of surgery and the typical environment, post-operative patients in intensive care units (ICUs) have higher incidence rates of POD than other patients [9]. POD is associated with several negative outcomes, including elevated morbidity and mortality, prolonged ICU stay, and extra medical expenses [11,12,13]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
