Systematic review and meta-analysis of the risk factors for postoperative delirium in patients with acute type A aortic dissection

Abstract

Background: Delirium is a common postoperative complication of acute type an aortic dissection, which is a serious threat to the patient's life after operation. However, there are many risk factors for delirium and there are different conclusions. The aim of this study was to systematically analyze the risk factors for postoperative delirium in patients with acute type a aortic dissection by means of meta-analysis. Methods: Literature related to the risk factors of postoperative delirium in patients with acute type A aortic dissection was searched via the China National Knowledge Infrastructure (CNKI), cqvip.com (VIP), WanFang, PubMed, Willey Library, Embase, and Web of Science databases. Two persons independently conducted literature screening, data extraction and literature quality evaluation according to the inclusion and exclusion criteria. The quality of literature was evaluated with Newcastle-Ottawa Scale (NOS). R 4.2.1 was used to compare the risk factors for meta-analysis. Results: After screening, 12 articles were included with a total of 2,511 cases, and 4 articles were at medium risk of bias and 8 articles were at low risk of bias. The meta-analysis results showed that patients in the delirium group had a higher probability of postoperative hypoxemia [odds ratio (OR) =1.65, 95% confidence interval (CI): 1.28–2.13, P<0.01], longer postoperative duration of ventilator assistance (OR =3.05, 95% CI: 2.47–3.77, P<0.01), higher incidence of renal insufficiency (OR =1.86, 95% CI: 1.33–2.58, P<0.01), lower hemoglobin levels (OR =0.33, 95% CI: 0.23–0.48, P<0.01), longer postoperative stay duration in the intensive care unit (ICU) (OR =2.25, 95% CI: 2.13–2.37, P<0.01), longer duration of hospitalization (OR =2.74, 95% CI: 2.37–3.16, P<0.01), and higher postoperative Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (OR =1.01, 95% CI: 0.90–1.12, P=0.92). Conclusions: Post-op aortic dissection in patients with acute type A diabetes should be monitored for oxygen and blood levels. When patients had prolonged mechanical ventilation, renal insufficiency, decreased hemoglobin, and prolonged ICU stay, timely intervention is needed to prevent the high-risk factors of postoperative delirium.