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

Figures & data

Figure 1 Study flow-chart.

Abbreviations: TBAD, type B aortic dissection; TEVAR, thoracic endovascular aortic repair.

Table 1 Baseline and Operative Characteristics of Patients with and without Delirium

Variables	Delirium (n=69)	No Delirium (n=448)	P
Age, years	55.5 ± 11.0	52.8 ± 10.9	0.048
Age ≥60 years	27 (39.1)	131 (29.2)	0.097
Male	390 (87.1)	63 (91.3)	0.318
BMI, kg/m^Citation2	24.5 ± 3.4	24.7 ± 3.9	0.723
Obesity (BMI ≥30 kg/m^2)	41 (9.2)	2 (2.9)	0.080
Phases of aortic dissection			0.217
Acute	66 (95.7)	409 (91.3)
Subacute	3 (4.3)	39 (8.7)
Hypertension	62 (89.9)	383 (85.5)	0.330
Coronary artery disease	12 (17.4)	61 (13.6)	0.402
Diabetes mellitus	5 (7.2)	25 (5.6)	0.579
Hyperlipidemia	8 (11.6)	52 (11.6)	0.998
Anemia	36 (52.2)	205 (45.8)	0.320
Stroke	3 (4.3)	8 (1.8)	0.171
Current smoker	35 (50.7)	228 (50.9)	0.979
Maximum aortic diameter, mm	39.0 (35.0–44.1)	37.0 (34.0–41.6)	0.012
Maximum aortic diameter ≥40 mm	32 (46.4)	147 (32.8)	0.027
Extent of the dissection			0.419
Confined in thoracic aorta	12 (17.4)	97 (21.7)
Extended to abdominal aorta	57 (82.6)	351 (78.3)
False lumen status			0.564
Patent	46 (66.7)	301 (67.2)
Partially thrombosed	22 (31.9)	128 (28.6)
Completely thrombosed	1 (1.4)	19 (4.2)
Pleural effusion	37 (53.6)	211 (47.1)	0.313
Pericardial effusion	5 (7.2)	19 (4.2)	0.349
Hemoglobin, g/L	129.0 (116.2–135.5)	131.5 (119.3–141.2)	0.059
Platelets, 10^9/L	188.4 (156.0–253.3)	198.2 (160.0–253.2)	0.554
lg (D-dimer)	3.3 ±0.6	3.3 ± 0.5	0.820
Creatinine, mg/dL	1.2 (0.9–2.0)	1.0 (0.8–1.3)	0.001
Creatinine >2 mg/dL	17 (24.6)	37 (8.3)	<0.001
Albumin, g/L	31.3 ± 4.9	32.8 ± 4.6	0.016
Albumin < 30 g/L	27 (39.1)	121 (27.0)	0.038
Blood glucose, mg/dL	122.2 (101.0–157.5)	113.4 (96.5–137.6)	0.101
Serum sodium, mmol/L	136.6 (135.5–139.9)	137.0 (134.6–138.8)	0.241
Serum potassium, mmol/L	3.8 (3.5–4.1)	3.7 (3.5–4.0)	0.165
Abnormal serum electrolyte^a	10 (14.5)	31 (6.9)	0.030
Operative procedure
TEVAR	38 (55.1)	281 (62.7)	0.224
Hybrid (TEVAR + aortic arch bypass)	25 (36.2)	95 (21.2)	0.006
Chimney	7 (10.1)	75 (16.7)	0.163
Insertion of ≥2 aortic stents	10 (14.5)	31 (6.9)	0.030
Perioperative blood transfusion	24 (34.8)	47 (10.5)	<0.001
Preoperative medication use
Antiplatelet drugs	7 (10.1)	61 (13.6)	0.427
Angiotensin system inhibitors	50 (72.5)	312 (69.6)	0.634
Beta-blockers	69 (100.0)	442 (98.7)	>0.999
Calcium channel blockers	69 (100.0)	431 (96.2)	0.147
Diuretics	38 (55.1)	255 (56.9)	0.773
Statins	39 (56.5)	247 (55.1)	0.829
Analgesics^b	42 (60.9)	262 (58.5)	0.708
Benzodiazepines	34 (49.3)	138 (30.8)	0.002
Zolpidem	2 (2.9)	10 (2.2)	0.667
Histamine-receptor antagonists	6 (8.7)	17 (3.8)	0.106
Quinolone	22 (31.9)	63 (14.1)	<0.001

Notes:^aAbnormal serum electrolyte indicates abnormal levels of sodium, potassium, or glucose. ^bAnalgesics indicate use of morphine, tramadol and fentanyl.

Abbreviations: BMI, body mass index; TEVAR, thoracic endovascular aortic repair.

Figure 2 Forest plot of POD predictors (A), and multivariable analysis results of follow-up mortality (B).

Abbreviations: POD, postoperative delirium; BMI, body mass index.

Table 2 Post-Operative Outcomes of Patients with and without Delirium

Variables	Delirium (n=69)	No Delirium (n=448)	P
Early outcomes
Hospital stay, days	19.0 (14.0–26.5)	13.0 (9.0–18.0)	<0.001
ICU stay, hours	144.0 (71.5–236.0)	5.5 (0–96.0)	<0.001
Prolonged ICU stay *	49 (71.0)	139 (31.0)	<0.001
Hospital costs, thousand dollars	26.8 (20.3–34.6)	20.8 (15.0–24.0)	<0.001
Death	6 (8.7)	9 (2.0)	0.009
Acute kidney injury	21 (30.4)	113 (25.2)	0.358
Stroke	11 (15.9)	6 (1.3)	<0.001
Limb ischemia	2 (2.9)	7 (1.6)	0.343
Spinal cord ischemia	5 (7.2)	2 (0.4)	0.001
Re-intervention	3 (4.3)	3 (0.7)	0.034
Follow-up outcomes
All-cause mortality	19 (30.2)	39 (8.9)	<0.001
Stroke	2 (3.2)	13 (3.0)	0.926
Re-intervention	2 (3.2)	24 (5.5)	0.759
Re-admission	8 (12.7)	60 (13.7)	0.834

Note: *Prolonged ICU stay was defined as intensive care unit stay greater than 72 hours.

Abbreviation: ICU, intensive care unit.

Table 3 Results of Multivariate Regression Analysis for Early Outcomes

Variables	Prolonged ICU Stay*		Death
	OR (95% CI)	P	OR (95% CI)	P
Delirium	4.39 (2.40–8.01)	<0.001	4.42 (1.26–15.54)	0.020

Note: *Prolonged ICU stay was defined as intensive care unit stay greater than 72 hours.

Abbreviations: OR, odds ratio; CI, confidence interval; ICU, intensive care unit.

Figure 3 The Kaplan-Meier survival curve of the association between postoperative delirium and follow-up survival.

CzernyM, SchmidliJ, AdlerS, et al. Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS). Eur J Cardiothorac Surg. 2019;55(1):133–162.30312382

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