Incidence, predictors and outcomes of delirium in complicated type b aortic dissection patients after thoracic endovascular aortic repair

Abstract

Purpose: The present study aimed to investigate the incidence and predictors of postoperative 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.