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

Clin Interv Aging. 2021 Aug 26:16:1581-1589. doi: 10.2147/CIA.S328657. eCollection 2021.

Abstract

Purpose: 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: hybrid procedure; outcomes; postoperative delirium; predictors; thoracic endovascular aortic repair; type B aortic dissection.

MeSH terms

  • Aortic Aneurysm, Thoracic* / surgery
  • Aortic Dissection* / surgery
  • Blood Vessel Prosthesis Implantation*
  • Cross-Sectional Studies
  • Delirium* / epidemiology
  • Endovascular Procedures*
  • Humans
  • Incidence
  • Male
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome

Grants and funding

This research was supported by grants from High-level Hospital Construction Project (grant no DFJH201807 and no DFJH201811), Guangdong Provincial Key Laboratory of Coronary Artery Disease Prevention Fund (grant no Y022017018) and Guangdong Provincial People’s Hospital Clinical Research Fund (grant no Y012018085). The funding bodies did not have any role in the design of the study, data collection, and analysis, nor on the interpretation and dissemination of the results.