Risk factors for postoperative delirium after Stanford type A aortic dissection : A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Pu ¹ ,  WU Qiaomei ² , GUO Shichang ¹ , WANG Mingxin ¹ , CHEN Meiying ¹ , MU Nan ¹ , TAN Wenting ²

1. The Second Clinical Medical College of Guangzhou University of Traditional Chinese Medicine, Guangzhou, 510006, P. R. China;
2. The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, 510120, P. R. China;

Corresponding?author：

WU Qiaomei, Email: wqm512@126.com

Keywords：

Stanford type A aortic dissection; postoperative delirium; risk factors; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202211001

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To systematically evaluate the risk factors for postoperative delirium after surgery for Stanford type A aortic dissection. Methods We searched the CNKI, SinoMed, Wanfang data, VIP, PubMed, Web of Science, EMbase, The Cochrane Library database from inception to September 2022. Case-control studies, and cohort studies on risk factors for postoperative delirium after surgery for Stanford type A aortic dissection were collected to identify studies about the risk factors for postoperative delirium after surgery for Stanford type A aortic dissection. Quality of the included studies was evaluated by the Newcastle-Ottawa scale (NOS). The meta-analysis was performed by RevMan 5.3 software and Stata 15.0 software. Results A total of 21 studies were included involving 3385 patients. The NOS score was 7-8 points. The results of meta-analysis showed that age (MD=2.58, 95%CI 1.44 to 3.72, P＜0.000 01), male (OR=1.33, 95%CI 1.12 to 1.59, P=0.001), drinking history (OR=1.45, 95%CI 1.04 to 2.04, P=0.03), diabetes history (OR=1.44, 95%CI 1.12 to 1.85, P=0.005), preoperative leukocytes (MD=1.17, 95%CI 0.57 to 1.77), P=0.000 1), operation time (MD=21.82, 95%CI 5.84 to 37.80, P=0.007), deep hypothermic circulatory arrest (DHCA) time (MD=3.02, 95%CI 1.04 to 5.01, P=0.003), aortic occlusion time (MD=8.94, 95%CI 2.91 to 14.97, P=0.004), cardiopulmonary bypass time (MD=13.92, 95%CI 5.92 to 21.91, P=0.0006), ICU stay (MD=2.77, 95%CI 1.55 to 3.99, P＜0.000 01), hospital stay (MD=3.46, 95%CI 2.03 to 4.89, P＜0.0001), APACHEⅡ score (MD=2.76, 95%CI 1.59 to 3.93, P＜0.000 01), ventilation support time (MD=6.10, 95%CI 3.48 to 8.72, P＜0.000 01), hypoxemia (OR=2.32, 95%CI 1.40 to 3.82, P=0.001), the minimum postoperative oxygenation index (MD=?79.52, 95%CI ?125.80 to ?33.24, P=0.000 8), blood oxygen saturation (MD=?3.50, 95%CI ?4.49 to ?2.51, P＜0.000 01), postoperative hemoglobin (MD=?6.35, 95%CI ?9.21 to ?3.50, P＜0.000 1), postoperative blood lactate (MD=0.45, 95%CI 0.15 to 0.75, P=0.004), postoperative electrolyte abnormalities (OR=5.94, 95%CI 3.50 to 10.09, P＜0.000 01), acute kidney injury (OR=1.92, 95%CI 1.34 to 2.75, P=0.000 4) and postoperative body temperature (MD=0.79, 95%CI 0.69 to 0.88, P＜0.000 01) were associated with postoperative delirium after surgery for Stanford type A aortic dissection. Conclusion The current evidence shows that age, male, drinking history, diabetes history, operation time, DHCA time, aortic occlusion time, cardiopulmonary bypass time, ICU stay, hospital stay, APACHEⅡ score, ventilation support time, hypoxemia and postoperative body temperature are risk factors for the postoperative delirium after surgery for Stanford type A aortic dissection. Oxygenation index, oxygen saturation, and hemoglobin number are protective factors for delirium after Stanford type A aortic dissection.

Citation： WANG Pu, WU Qiaomei, GUO Shichang, WANG Mingxin, CHEN Meiying, MU Nan, TAN Wenting. Risk factors for postoperative delirium after Stanford type A aortic dissection : A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(5): 791-799. doi: 10.7507/1007-4848.202211001 Copy

1.	Elsayed RS, Cohen RG, Fleischman F, et al. Acute type A aortic dissection. Cardiol Clin, 2017, 35(3): 331-345.
2.	Gudbjartsson T, Ahlsson A, Geirsson A, et al. Acute type A aortic dissection—A review. Scand Cardiovasc J, 2020, 54(1): 1-13.
3.	Whitlock EL, Torres BA, Lin N, et al. Postoperative delirium in a substudy of cardiothoracic surgical patients in the BAG-RECALL clinical trial. Anesth Analg, 2014, 118(4): 809-817.
4.	Krzych LJ, Wybraniec MT, Krupka-Matuszczyk I, et al. Complex assessment of the incidence and risk factors of delirium in a large cohort of cardiac surgery patients: A single-center 6-year experience. Biomed Res Int, 2013, 2013: 835850.
5.	Rudolph JL, Marcantonio ER. Review articles: Postoperative delirium: Acute change with long-term implications. Anesth Analg, 2011, 112(5): 1202-1211.
6.	Chen H, Mo L, Hu H, et al. Risk factors of postoperative delirium after cardiac surgery: A meta-analysis. J Cardiothorac Surg, 2021, 16(1): 113.
7.	周楚芝, 楊建安, 溫雋珉, 等. 急性A型主動脈夾層患者術后譫妄發生的危險因素分析. 中國動脈硬化雜志, 2016, 24(12): 1253-1257.
8.	王殊. Stanford A型主動脈夾層術后譫妄危險因素分析. 南京醫科大學, 2018.
9.	王晨雷. Stanford A型主動脈夾層術后譫妄狀態的臨床特點和相關危險因素研究. 昆明醫科大學, 2016.
10.	宋先榮, 程兆云, 劉富榮, 等. Stanford A型主動脈夾層術后譫妄的臨床研究. 中華胸心血管外科雜志, 2016, 32(10): 607-611.
11.	陸地, 周曉東, 王玨, 等. Stanford A型主動脈夾層患者發生術后譫妄的危險因素研究. 浙江醫學, 2022, 44(5): 480-483.
12.	李曉晴, 馬聞建, 畢齊, 等. A型主動脈夾層術后譫妄的發生率和危險因素研究. 安徽醫藥, 2014, 18(6): 1065-1069.
13.	黃真鋒, 法憲恩, 王宏山, 等. 急性主動脈夾層弓部手術后譫妄的臨床研究. 東南大學學報(醫學版), 2018, 37(2): 259-262.
14.	Shi Q, Mu X, Zhang C, et al. Risk factors for postoperative delirium in type A aortic dissection patients: A retrospective study. Med Sci Monit, 2019, 25: 3692-3699.
15.	Liu Z, Pang X, Zhang X, et al. Incidence and risk factors of delirium in patients after type-A aortic dissection surgery. J Cardiothorac Vasc Anesth, 2017, 31(6): 1996-1999.
16.	朱悅倩, 楊菁, 孫煦, 等. 急性Stanford A型夾層術后譫妄的危險因素分析. 實用醫學雜志, 2020, 36(7): 940-943.
17.	孫芳, 施乾坤, 章淬, 等. 急性主動脈夾層術后譫妄狀態的高危因素分析. 臨床薈萃, 2014, 29(7): 721-724.
18.	牛永勝, 李莉, 魏海燕, 等. 急性A型主動脈夾層患者術后譫妄的危險因素. 臨床麻醉學雜志, 2022, 38(6): 622-626.
19.	賀清, 薛超, 李步瀠, 等. StanfordA型主動脈夾層動脈瘤患者雜交手術后譫妄特征及發生的危險因素分析. 陜西醫學雜志, 2020, 49(11): 1432-1435.
20.	方妙弦, 熊衛萍, 曾嶸, 等. Stanford A型主動脈夾層患者術后譫妄的危險因素分析. 中國胸心血管外科臨床雜志, 2016, 23(4): 357-361.
21.	成麗敏. 主動脈夾層術后譫妄的危險因素及預防. 國際護理學雜志, 2020, 39(10): 1862-1864.
22.	白耀邦, 李培軍, 吳振華, 等. Stanford A型主動脈夾層患者術后譫妄的相關危險因素分析. 天津醫藥, 2018, 46(5): 471-474.
23.	Lv XC, Lin Y, Wu QS, et al. Plasma interleukin-6 is a potential predictive biomarker for postoperative delirium among acute type a aortic dissection patients treated with open surgical repair. J Cardiothorac Surg, 2021, 16(1): 146.
24.	Cai S, Zhang X, Pan W, et al. Prevalence, predictors, and early outcomes of post-operative delirium in patients with type A aortic dissection during intensive care unit stay. Front Med (Lausanne), 2020, 7: 572581.
25.	Lin YJ, Lin LY, Peng YC, et al. Association between glucose variability and postoperative delirium in acute aortic dissection patients: An observational study. J Cardiothorac Surg, 2021, 16(1): 82.
26.	閆曉英, 劉哲, 宋艷, 等. A型主動脈夾層術患者術后譫妄的影響因素分析. 護理實踐與研究, 2020, 17(1): 7-10.
27.	李雪蘋, 王磊, 張淮, 等. Stanford A型主動脈夾層患者術后譫妄風險預測評分模型的構建與效果驗證. 中華護理雜志, 2022, 57(8): 950-957.
28.	David TE, Maganti M, Armstrong S. Aortic root aneurysm: Principles of repair and long-term follow-up. J Thorac Cardiovasc Surg, 2010, 140(6 Suppl): S14-S19.
29.	伍僑. 老年術后譫妄發生率及危險因素的系統評價. 成都中醫藥大學, 2021.
30.	李冰冰, 覃穎, 張艷. 老年髖部骨折病人術后譫妄早期識別的研究進展. 護理研究, 2020, 34(16): 2888-2891.
31.	He J, Ling Q, Chen Y. Construction and application of a model for predicting the risk of delirium in postoperative patients with type A aortic dissection. Front Surg, 2021, 8: 772675.
32.	李瑛, 李賢煌, 胡燕, 等. 心臟外科術后患者發生譫妄危險因素的Meta分析. 解放軍護理雜志, 2022, 39(6): 72-76.
33.	Zhang G, Wang Z, Wang D, et al. A systematic review and meta-analysis of the correlation between operation time and postoperative delirium in total hip arthroplasty. Ann Palliat Med, 2021, 10(10): 10459-10466.
34.	Bucerius J, Gummert JF, Borger MA, et al. Predictors of delirium after cardiac surgery delirium: effect of beating-heart (off-pump) surgery. J Thorac Cardiovasc Surg, 2004, 127(1): 57-64.
35.	Stransky M, Schmidt C, Ganslmeier P, et al. Hypoactive delirium after cardiac surgery as an independent risk factor for prolonged mechanical ventilation. J Cardiothorac Vasc Anesth, 2011, 25(6): 968-974.
36.	Bakker RC, Osse RJ, Tulen JH, et al. Preoperative and operative predictors of delirium after cardiac surgery in elderly patients. Eur J Cardiothorac Surg, 2012, 41(3): 544-549.
37.	包萌萌, 魏昌偉, 吳安石. 術后譫妄預測及診斷的研究進展. 中華麻醉學雜志, 2020, 40(4): 504-508.
38.	van den Akker JP, Egal M, Groeneveld AB. Invasive mechanical ventilation as a risk factor for acute kidney injury in the critically ill: A systematic review and meta-analysis. Crit Care, 2013, 17(3): R98.
39.	王明欣, 周春姣, 嵇星辰, 等. 食管癌患者術后肺部感染危險因素的系統評價與Meta分析. 中國胸心血管外科臨床雜志, 2023, 30(10): 1467-1474.

1. Elsayed RS, Cohen RG, Fleischman F, et al. Acute type A aortic dissection. Cardiol Clin, 2017, 35(3): 331-345.
2. Gudbjartsson T, Ahlsson A, Geirsson A, et al. Acute type A aortic dissection—A review. Scand Cardiovasc J, 2020, 54(1): 1-13.
3. Whitlock EL, Torres BA, Lin N, et al. Postoperative delirium in a substudy of cardiothoracic surgical patients in the BAG-RECALL clinical trial. Anesth Analg, 2014, 118(4): 809-817.
4. Krzych LJ, Wybraniec MT, Krupka-Matuszczyk I, et al. Complex assessment of the incidence and risk factors of delirium in a large cohort of cardiac surgery patients: A single-center 6-year experience. Biomed Res Int, 2013, 2013: 835850.
5. Rudolph JL, Marcantonio ER. Review articles: Postoperative delirium: Acute change with long-term implications. Anesth Analg, 2011, 112(5): 1202-1211.
6. Chen H, Mo L, Hu H, et al. Risk factors of postoperative delirium after cardiac surgery: A meta-analysis. J Cardiothorac Surg, 2021, 16(1): 113.
7. 周楚芝, 楊建安, 溫雋珉, 等. 急性A型主動脈夾層患者術后譫妄發生的危險因素分析. 中國動脈硬化雜志, 2016, 24(12): 1253-1257.
8. 王殊. Stanford A型主動脈夾層術后譫妄危險因素分析. 南京醫科大學, 2018.
9. 王晨雷. Stanford A型主動脈夾層術后譫妄狀態的臨床特點和相關危險因素研究. 昆明醫科大學, 2016.
10. 宋先榮, 程兆云, 劉富榮, 等. Stanford A型主動脈夾層術后譫妄的臨床研究. 中華胸心血管外科雜志, 2016, 32(10): 607-611.
11. 陸地, 周曉東, 王玨, 等. Stanford A型主動脈夾層患者發生術后譫妄的危險因素研究. 浙江醫學, 2022, 44(5): 480-483.
12. 李曉晴, 馬聞建, 畢齊, 等. A型主動脈夾層術后譫妄的發生率和危險因素研究. 安徽醫藥, 2014, 18(6): 1065-1069.
13. 黃真鋒, 法憲恩, 王宏山, 等. 急性主動脈夾層弓部手術后譫妄的臨床研究. 東南大學學報(醫學版), 2018, 37(2): 259-262.
14. Shi Q, Mu X, Zhang C, et al. Risk factors for postoperative delirium in type A aortic dissection patients: A retrospective study. Med Sci Monit, 2019, 25: 3692-3699.
15. Liu Z, Pang X, Zhang X, et al. Incidence and risk factors of delirium in patients after type-A aortic dissection surgery. J Cardiothorac Vasc Anesth, 2017, 31(6): 1996-1999.
16. 朱悅倩, 楊菁, 孫煦, 等. 急性Stanford A型夾層術后譫妄的危險因素分析. 實用醫學雜志, 2020, 36(7): 940-943.
17. 孫芳, 施乾坤, 章淬, 等. 急性主動脈夾層術后譫妄狀態的高危因素分析. 臨床薈萃, 2014, 29(7): 721-724.
18. 牛永勝, 李莉, 魏海燕, 等. 急性A型主動脈夾層患者術后譫妄的危險因素. 臨床麻醉學雜志, 2022, 38(6): 622-626.
19. 賀清, 薛超, 李步瀠, 等. StanfordA型主動脈夾層動脈瘤患者雜交手術后譫妄特征及發生的危險因素分析. 陜西醫學雜志, 2020, 49(11): 1432-1435.
20. 方妙弦, 熊衛萍, 曾嶸, 等. Stanford A型主動脈夾層患者術后譫妄的危險因素分析. 中國胸心血管外科臨床雜志, 2016, 23(4): 357-361.
21. 成麗敏. 主動脈夾層術后譫妄的危險因素及預防. 國際護理學雜志, 2020, 39(10): 1862-1864.
22. 白耀邦, 李培軍, 吳振華, 等. Stanford A型主動脈夾層患者術后譫妄的相關危險因素分析. 天津醫藥, 2018, 46(5): 471-474.
23. Lv XC, Lin Y, Wu QS, et al. Plasma interleukin-6 is a potential predictive biomarker for postoperative delirium among acute type a aortic dissection patients treated with open surgical repair. J Cardiothorac Surg, 2021, 16(1): 146.
24. Cai S, Zhang X, Pan W, et al. Prevalence, predictors, and early outcomes of post-operative delirium in patients with type A aortic dissection during intensive care unit stay. Front Med (Lausanne), 2020, 7: 572581.
25. Lin YJ, Lin LY, Peng YC, et al. Association between glucose variability and postoperative delirium in acute aortic dissection patients: An observational study. J Cardiothorac Surg, 2021, 16(1): 82.
26. 閆曉英, 劉哲, 宋艷, 等. A型主動脈夾層術患者術后譫妄的影響因素分析. 護理實踐與研究, 2020, 17(1): 7-10.
27. 李雪蘋, 王磊, 張淮, 等. Stanford A型主動脈夾層患者術后譫妄風險預測評分模型的構建與效果驗證. 中華護理雜志, 2022, 57(8): 950-957.
28. David TE, Maganti M, Armstrong S. Aortic root aneurysm: Principles of repair and long-term follow-up. J Thorac Cardiovasc Surg, 2010, 140(6 Suppl): S14-S19.
29. 伍僑. 老年術后譫妄發生率及危險因素的系統評價. 成都中醫藥大學, 2021.
30. 李冰冰, 覃穎, 張艷. 老年髖部骨折病人術后譫妄早期識別的研究進展. 護理研究, 2020, 34(16): 2888-2891.
31. He J, Ling Q, Chen Y. Construction and application of a model for predicting the risk of delirium in postoperative patients with type A aortic dissection. Front Surg, 2021, 8: 772675.
32. 李瑛, 李賢煌, 胡燕, 等. 心臟外科術后患者發生譫妄危險因素的Meta分析. 解放軍護理雜志, 2022, 39(6): 72-76.
33. Zhang G, Wang Z, Wang D, et al. A systematic review and meta-analysis of the correlation between operation time and postoperative delirium in total hip arthroplasty. Ann Palliat Med, 2021, 10(10): 10459-10466.
34. Bucerius J, Gummert JF, Borger MA, et al. Predictors of delirium after cardiac surgery delirium: effect of beating-heart (off-pump) surgery. J Thorac Cardiovasc Surg, 2004, 127(1): 57-64.
35. Stransky M, Schmidt C, Ganslmeier P, et al. Hypoactive delirium after cardiac surgery as an independent risk factor for prolonged mechanical ventilation. J Cardiothorac Vasc Anesth, 2011, 25(6): 968-974.
36. Bakker RC, Osse RJ, Tulen JH, et al. Preoperative and operative predictors of delirium after cardiac surgery in elderly patients. Eur J Cardiothorac Surg, 2012, 41(3): 544-549.
37. 包萌萌, 魏昌偉, 吳安石. 術后譫妄預測及診斷的研究進展. 中華麻醉學雜志, 2020, 40(4): 504-508.
38. van den Akker JP, Egal M, Groeneveld AB. Invasive mechanical ventilation as a risk factor for acute kidney injury in the critically ill: A systematic review and meta-analysis. Crit Care, 2013, 17(3): R98.
39. 王明欣, 周春姣, 嵇星辰, 等. 食管癌患者術后肺部感染危險因素的系統評價與Meta分析. 中國胸心血管外科臨床雜志, 2023, 30(10): 1467-1474.

Previous Article
MiR-31a-5p aggravates apoptosis in myocardial ischemia by targeting HIF-1α
Next Article
Status and prospect of transcatheter valve-in-valve implantation for biological valve degeneration

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors for postoperative delirium after Stanford type A aortic dissection : A systematic review and meta-analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content