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Risk factors for prolonged postoperative ICU stay in the patients with Stanford type A aortic dissection

Haiyuan Liu¹, Shuaipeng Zhang¹, Chengxin Zhang¹

¹Department of Cardiovascular Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, 230061, Anhui Province, China.

Journal of Cardiothoracic Surgery

|February 3, 2024

Insights

Emergency surgery, elevated preoperative urea nitrogen, and longer cardiopulmonary bypass times are key risk factors for prolonged intensive care unit (ICU) stays following Stanford type A aortic dissection (TAAD) repair. These factors are linked to poorer patient outcomes, necessitating proactive management strategies.

Area of Science:

Cardiovascular Surgery
Thoracic Aortic Disease
Intensive Care Medicine

Background:

Stanford type A aortic dissection (TAAD) is a life-threatening condition requiring complex surgical intervention.
Prolonged intensive care unit (ICU) stay post-TAAD surgery is associated with increased morbidity and mortality.
Identifying independent risk factors for prolonged ICU stay is crucial for optimizing patient management and outcomes.

Purpose of the Study:

To identify independent risk factors predicting prolonged ICU stay after TAAD surgery.
To evaluate the clinical outcomes associated with prolonged ICU stay in TAAD patients.

Main Methods:

Retrospective analysis of 100 TAAD patients undergoing surgery between December 2018 and September 2022.
Patients were categorized into regular (<7 days) and prolonged (≥7 days) ICU stay groups.
Univariate and logistic regression analyses were performed to determine independent risk factors; clinical outcomes were compared between groups.

Main Results:

Independent risk factors for prolonged ICU stay included emergency surgery, elevated preoperative urea nitrogen, and longer cardiopulmonary bypass (CPB) time.
The combination of these factors demonstrated significant predictive value (AUC=0.810).
Patients with prolonged ICU stays experienced significantly higher rates of adverse events, including limb disability, severe organ injury, tracheotomy, and reintubation.

Conclusions:

Emergency surgery, preoperative urea nitrogen levels, and CPB duration are significant risk factors for prolonged ICU stay after TAAD repair.
Prolonged ICU stay correlates with worse postoperative clinical outcomes.
Proactive strategies targeting these risk factors are essential to reduce ICU duration and improve patient outcomes.

Read full analysis

Abstract

Objective:

To investigate the independent risk factors for postoperative prolonged ICU stay in patients with Stanford type A aortic dissection (TAAD) and assess the clinical outcomes of prolonged ICU stay.

Method:

The clinical data of 100 patients with TAAD admitted to the Department of Cardiovascular Surgery, First Affiliated Hospital of Anhui Medical University from December 2018 to September 2022 were retrospectively collected and analyzed. Patients were divided into two groups, based on the postoperative ICU stay (7 days as the threshold), regular ICU stay group (< 7 days) and prolonged ICU stay group (≥ 7 days). First, preoperative and intraoperative materials were collected for univariate analysis. Then, the significant variables after univariate analysis were analyzed using logistic regression, and the final independent risk factors for prolonged ICU stay were determined. Meanwhile, the postoperative clinical outcomes were analyzed with the aim of assessing the clinical outcomes due to prolonged ICU stay.

Results:

There were 65 and 35 patients in the regular ICU stay group and the prolonged ICU stay group, respectively. In accordance with the result of univariate analysis in the two groups, emergency surgery (χ² = 13.598; P < 0.001), preoperative urea nitrogen (t = 3.006; P = 0.004), cardiopulmonary bypass (CPB) time (t = 2.671; P = 0.001) and surgery time (t = 2.630; P = 0.010) were significant. All significant variates were analyzed through logistic regression, and it was found that emergency surgery (OR = 0.192; 95% CI: 0.065-0.561), preoperative urea nitrogen (OR = 0.775; 95% CI: 0.634-0.947) and cardiopulmonary time (OR = 0.988; 95% CI: 0.979-0.998) were independent risk factors for prolonged postoperative ICU stay. The Receiver Operating Characteristic (ROC) curves of these three factors were also effective in predicting postoperative prolonged ICU stay (Emergency surgery, AUC = 0.308, 95% CI: 0.201-0.415; Preoperative urea nitrogen, AUC = 0.288, 95% CI: 0.185-0.392; cardiopulmonary time, AUC = 0.340, 95% CI: 0.223-0.457). Moreover, compared with a single factor, the predictive value of combined factors was more significant (AUC = 0.810, 95% CI: 0.722-0.897). For the comparison of postoperative data in the two groups,, compared with the regular ICU stay group, the incidence of adverse events in the prolonged ICU stay group increased significantly, including limb disability of limbs (χ² = 22.182; P < 0.001), severe organ injury (χ² = 23.077; P < 0.001), tracheotomy (χ² = 17.582; P < 0.001), reintubation (χ² = 28.020; P < 0.001), 72 h tracheal extubation after surgery (χ² = 29.335; P < 0.001), 12 h consciousness recovery after surgery (χ² = 18.445; P < 0.001), ICU re-entering (χ² = 9.496; P = 0.002) and irregular discharging (χ² = 24.969; P < 0.001).

Conclusion:

Emergency surgery, preoperative urea nitrogen, and CPB time are risk factors for postoperative prolonged ICU stay after TAAD surgery. Furthermore, prolonged ICU stay is associated with worse clinical outcomes. Hence, a reasonable strategy should be adopted proactively focusing on the risk factors to shorten ICU stays and improve clinical outcomes.

Keywords:

Prolonged ICU stay Risk factors Stanford type A aortic dissection

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