AKI - Acute Kidney Injury, Aortic Dissection, Coma, Delirium, Paraplegia, Stroke
Conditions
Keywords
Acute type A aortic dissection, Neurological complications, Intensive care unit, ICU workload, ICU length of stay, Mechanical ventilation, Hospital length of stay, Retrospective cohort, Nursing workload, Taiwan
Brief summary
Single-center retrospective cohort at China Medical University Hospital (Taichung, Taiwan) using fully de-identified electronic health records. Consecutive adults who underwent emergency repair of acute type A aortic dissection between 2021-01-01 and 2025-04-30 were pooled into one cohort. The study measures the incidence and patterns of early postoperative neurological complications and evaluates their association with intensive care unit (ICU) resource use, focusing on prolonged ICU length of stay (LOS ≥ 10 days), ICU and hospital LOS, and duration of mechanical ventilation (MV). No new data collection or patient contact occurs. Institutional Review Board (IRB) approval: CMUH114-REC1-139.
Detailed description
Adults (≥ 18 years) undergoing emergency repair for acute type A aortic dissection (ATAAD) at China Medical University Hospital (CMUH) during 2021-01-01 to 2025-04-30 were screened. Exclusions: missing key variables, preoperative stroke within 30 days or modified Rankin Scale (mRS) ≥ 4, pregnancy. The analytic cohort included 274 of 309 screened patients. Neurological complications comprise radiology-confirmed stroke, other focal neurological deficits, paraplegia, or sustained coma/encephalopathy recorded by neurology consultation. Prolonged ICU stay is prespecified as ICU LOS ≥ 10 days in the index admission. Outcomes: primary outcomes are prolonged ICU stay and any postoperative neurological complication; secondary outcomes are ICU LOS (days), duration of mechanical ventilation (hours), hospital LOS (days), in-hospital mortality, and in-hospital death within 30 days of the index surgery. Analyses are performed in R version 4.5.1. Continuous variables are summarized as medians with interquartile ranges (IQRs) and compared using the Mann-Whitney U test; categorical variables are presented as counts and percentages and compared using chi-square or Fisher exact tests. Multivariable logistic regression identifies factors associated with prolonged ICU stay (ICU LOS ≥ 10 days) among hospital survivors using a priori covariates (age, sex, chronic kidney disease stage 4-5, operation time, cardiopulmonary bypass \[CPB\] time, intraoperative red blood cell \[RBC\] units transfused, postoperative acute kidney injury \[AKI\], any postoperative neurological complication). A prespecified sensitivity analysis in the full cohort treats the endpoint as ICU LOS ≥ 10 days or in-hospital death using the same prespecified covariates. Data were de-identified before analysis and stored on secure hospital servers; the study is minimal risk and does not involve United States Food and Drug Administration (US FDA) regulated products.
Interventions
None listed
Sponsors
China Medical University Hospital
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults (≥18 years) who underwent emergency repair of acute type A aortic dissection at China Medical University Hospital between 2021-01-01 and 2025-04-30.
Exclusion criteria
* Missing data in key variables required for analyses. * Preoperative ischemic stroke within 30 days before surgery or preoperative modified Rankin Scale ≥4. * Pregnancy.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Prolonged ICU length of stay (LOS ≥10 days) | Through ICU discharge during the index admission (up to 30 days). | Proportion of participants with ICU LOS ≥10 days during the index ICU admission. Unit of measure: percent. |
| Any postoperative neurological complication | Through hospital discharge during the index admission (up to 30 days). | Proportion with stroke (CT/MRI confirmed), other focal neurological deficits, paraplegia, or sustained coma/encephalopathy recorded by neurology consultation. Unit of measure: percent. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hospital length of stay (days) | Through hospital discharge during the index admission (up to 65 days). | Days from hospital admission to discharge; deaths counted up to date of death. Unit of measure: days. |
| ICU length of stay (days) | Through ICU discharge during the index admission (up to 30 days). | ICU LOS summarized as median and IQR; larger values indicate greater resource use. Unit of measure: days. |
| In-hospital mortality within 30 days | Up to 30 days after index surgery, during the index hospitalization. | All-cause death occurring during the index hospitalization within 30 days after the index surgery (deaths after hospital discharge were not captured). |
| In-hospital mortality | Through hospital discharge during the index admission (up to 30 days). | All-cause death before discharge from the index hospitalization. Unit of measure: percent. |
| Duration of mechanical ventilation (hours) | Through final extubation during the index hospitalization (up to 40 days). | Cumulative hours of invasive ventilation from ICU arrival to final extubation. Unit of measure: hours. |
Countries
Taiwan
Outcome results
None listed