Incidence and Risk Factors of Delirium in Patients After Type-A Aortic Dissection Surgery

Objective: To study the incidence and related risk factors for postoperative delirium after type-A aortic dissection in patients who underwent Sun's procedure (total arch replacement using a tetrafurcate graft with stented elephant trunk implantation). Design: A retrospective study. Setting: A cardiac surgical intensive care unit. Participants: The study comprised 100 patients admitted to the intensive care unit for type-A aortic dissection. Interventions: All patients underwent Sun's procedure with uniform preoperative and anesthetic treatment. Measurements and Main Results: Delirium was evaluated using the Confusion Assessment Method for the intensive care unit. Baseline demographics and preoperative, intraoperative, and postoperative data were recorded and analyzed retrospectively via univariate analysis and multivariate logistic regression. The incidence of postoperative delirium was 34%, according to Confusion Assessment Method for the intensive care unit criteria. Univariate analysis revealed that 17 variables differed significantly among patients with and without delirium. Additional multivariate stepwise logistic regression analysis confimied that cerebrovascular disease history. surgery duration, cardiopulmonary bypass duration, intubation time, and hypoxia were strongly associated with postoperative delirium. Conclusions: Delirium is a common postoperative complication of aortic dissection. Cerebrovascular disease history, surgery and cardiopulmonary bypass duration, postoperative hypoxia, and intubation time are independently associated with the development of delirium. Early diagnosis of delirium and modifying these factors properly may be helpful to improve patients' prognosis. (C) 2017 Published by Elsevier Ltd.