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

Wang, Hongtao; Wang, Tianguang; Zhao, Chaoyang; Lin, Dewen

doi:10.21037/jtd-23-10

Cited by 4 publications

(4 citation statements)

References 14 publications

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“…Crawford et al [24] reported that a study of head and neck oral cancer in the West of Scotland found that male patients were more likely to develop POD than female patients. A systematic evaluation of risk factors for POD in Stanford type A aortic coarctation suggested that the risk of POD in male patients was 1.33 times higher than in women [25]. However, the gender factor is still controversial.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram model for predicting postoperative delirium in older adults undergoing free flap reconstruction after oral cancer surgery

Ying,

Xiaona,

Aili

et al. 2024

Preprint

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Objective: This study aimed to develop and internally validate a dynamic a nomogram model by analysing the risk factors for postoperative delirium (POD) in elderly patients undergoing free flap reconstruction for oral cancer. Methods: This was a single-centre, retrospective study. We used the convenience sampling method to select 359 elderly oral cancer patients from January 2020-August 2023 in the Oral and Maxillofacial Surgery Ward of Nanjing Stomatological Hospital as the study population. The original dataset was randomly divided into a training group (n=252) and a validation group (n=107) by a computer-generated random number sequence in a 7:3 ratio. Least Absolute Shrinkage and Selection Operator Regression (LASSO regression) were used to screen the best predictor variables. Logistic regression was used to build the model and visualized by nomogram. The performance of the model was evaluated by area under the curve (AUC), calibration curve and decision curve analysis (DCA). Results: Our prediction model showed that six variables, age, sex, marriage, preoperative anxiety, preoperative sleep disorder, and ICU length of stay, were associated with POD. The nomogram showed high predictive accuracy with an AUC of 0.82 (95% CI: 0.76-0.87) for the training group and 0.84 (95% CI: 0.76-0.92) for the internal validation group. In both the training and validation groups, there was good agreement between the predicted results and the true observations. Decision curve analyses in the training and validation groups showed that the predictive model had a good net clinical benefit. Conclusion: We developed a new predictive model to predict risk factors for POD in elderly oral cancer patients. This simple and reliable nomogram can help physicians assess POD quickly and effectively, and has the potential to be widely used in the clinic after more external validation.

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Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram model for predicting postoperative delirium in older adults undergoing free flap reconstruction after oral cancer surgery

Ying,

Xiaona,

Aili

et al. 2024

Preprint

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“…There are a few data regarding SCI in ATTAD. One study reports that 1% of patients presenting with ATAAD have SCI [25] A systematic meta-synthesis literature review found 67 cases of SCI caused by aortic dissection (type A and type B). Out of 19 patients having undergone emergency surgery, full recovery in 13 patients, residual paraplegia in 4 patients, and death in 2 patients was observed.…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative delirium is a severe brain disorder characterized by inattention, disturbed thinking and altered levels of consciousness [25,26]. A meta-analysis of 12 studies from 2016 to 2022 found that low oxygen levels, prolonged mechanical ventilation, renal dysfunction, low hemoglobin levels and prolonged intensive care stay are risk factors for PD in ATAAD [21].…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Newly Developed Postoperative Neurological Complications in Patients with Emergency Surgery for Acute Type A Aortic Dissection

Robu,

Margarint,

Robu

et al. 2023

Medicina

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Background and Objectives: Postoperative neurological complications (NCs) are an important cause of mortality in patients with acute type A aortic dissection (ATAAD). The aim of the study was to determine the association between intraoperative risk factors and newly developed postoperative NCs in patients after emergency surgery for ATAAD. Materials and Methods: A total of 203 patients requiring emergency surgery were included in the study. Patients with preoperative neurological dysfunction, deceased on the operating table or within the first 48 h after intensive care admission, with uncertain postoperative neurologic status or with incomplete records were excluded. Results: Mean age was 57.61 ± 12.27 years. Hyperlipidemia was the most frequent comorbidity (69%). A bicuspid aortic valve was present in 12.8% of cases, severe acute aortic regurgitation was present in 29.1% of patients, and cardiac tamponade was present in 27.1% of cases. The innominate artery was the most frequently dissected supra-aortic artery in 27.1% of cases. In 65% of cases, the primary entry tear was at the level of the ascending aorta. The incidence of newly developed postoperative NCs was 39.4%. The most common surgical technique performed was supra-coronary ascending aorta and hemiarch replacement, in 53.2% of patients. Using logistic regression, cardiopulmonary bypass time (OR = 1.01; 95% CI = 1.01–1.02; p < 0.001), aortic cross-clamp time over 3 h (OR = 2.71, 95% CI = 1.43–5.14, p = 0.002) and cerebral perfusion time (OR = 1.02; 95% CI = 1.002–1.03; p = 0.027) were independently associated with newly developed postoperative NCs. Conclusions: Based on the results of the study, all efforts should be made to reduce operative times. Using a simple surgical technique, like the supra-coronary ascending aorta and hemiarch technique, whenever possible, and using a simpler technique for cerebral perfusion like unilateral cerebral perfusion via the right axillary artery, could reduce operating times.

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“…Surgical repair of dissection located in the ascending aorta and aortic arch affect cerebral perfusion, so the incidence of POD is higher than in other cardiac operations [8]. Chinese literature publications [9][10][11] report an incidence rate of 21.95%~55.68%, and other countries' publications [12,13] report an incidence rate of 8.00%~52.00%. Once a patient develops POD, the risk of nosocomial infection is increased, an increase is also seen in mortality rate and medical expenses [14], as well as extended hospital stay by 2 to 3 days [15].…”

Section: Introductionmentioning

confidence: 99%

Construction of a postoperative delirium nursing care plan for patients with Stanford type A aortic dissection：A Delphi study

Li,

Lin

et al. 2024

Preprint

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Aim To develop a plan for care of postoperative delirium in patients with Stanford type A aortic dissection in the ward, and to provide reference for the prevention and care of postoperative delirium in such patients. Background Postoperative delirium is one of the common and serious postoperative complications in patients with type A aortic dissection. It can significantly affect surgical efficacy and postoperative recovery. However, there is currently lack of effective postoperative management programs. Design: This study adopted evidence-based nursing research and the Delphi expert consensus method. Methods: Through literature research, group discussions, and evidence-based nursing research, a plan for postoperative delirium care for patients with type A aortic dissection in the ward was formulated. The retrieval time is from establishment of the database to May 2022. The plan was modified through two rounds of Delphi expert consultation to form the final draft. Results After two rounds of Delphi expert consultation, the expert authority coefficient, concentration degree and degree of coordination of expert opinions, all showed good results. The content of the plan includes 5 primary components (delirium judgment, delirium risk stratification and related assessment, general management, management of patients with delirium, family caregiver support), 18 secondary components, and 47 tertiary components. Conclusion This protocol has good accuracy and operability, and provides a reliable basis for the management of postoperative delirium in patients with type A aortic dissection in the general wards. Implications for Nursing Management: This study can provide a reference for clinical nurses to implement in the management of postoperative delirium and provide a theoretical basis for perpetual improvement of postoperative nursing quality in cardiac surgery.

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

Cited by 4 publications

References 14 publications

Development and validation of a nomogram model for predicting postoperative delirium in older adults undergoing free flap reconstruction after oral cancer surgery

Development and validation of a nomogram model for predicting postoperative delirium in older adults undergoing free flap reconstruction after oral cancer surgery

Factors Associated with Newly Developed Postoperative Neurological Complications in Patients with Emergency Surgery for Acute Type A Aortic Dissection

Construction of a postoperative delirium nursing care plan for patients with Stanford type A aortic dissection：A Delphi study

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