Prediction And Prognosis Of Respiratory Complications After Surgery For Stanford Type A Aortic Dissection

Objective: Respiratory complications are prevalent after operation for Stanford type A aortic dissection(AAD),closely related to postoperative adverse outcomes.At present,many reports on the study of respiratory complications in other diseases and surgeries have been published,however,there are still few reports on respiratory complications after AAD surgery(AADS) orldwide.The objective of the current study was to establish early risk prediction models including preoperative and intraoperative variables by investigating the independent risk factors and clinical outcomes of various respiratory complications after AADS,and to clarify the effect of various respiratory complications on in-hospital outcomes and long-term prognosis.We then aimed to discuss the strategies of preventing respiratory complications and improving the prognosis,and to provide evidence-based support for clinical prevention and treatment.Methods: We collected the clinical data of patients who underwent AADS in the Department of Cardiovascular Surgery,Wuhan Union Hospital from January-2016 to December-2019. Patients were divided into two independent groups based on the development of postoperative respiratory complications.Independent predictors for respiratory complications were identified by univariate and multivariate analysis and clinical prediction models were then established. The relationship between respiratory complications and clinical outcomes was determined by univariate and propensity score matching analysis.Results:After selection,492 patients were included in this study.The independent predictors for various respiratory complications including postoperative severe hypoxemia,pneumonia,reintubation,and tracheostomy after AADS were identified by systematical statistical analysis,including age,body mass index,smoking history,emphysema,cerebrovascular disease,renal insufficiency,white blood cell count,platelet count,cardiopulmonary bypass time,intraoperative transfusion of red blood cell and platelet.The clinical prediction model,nomogram and risk calculator established based on the independent risk factors showed good discriminative ability,calibration and clinical utility.These respiratory complications can increase the risk of various adverse outcomes during hospitalization to some extent,however,no significant effect of respiratory complications on long-term prognosis has been observed for patients who were discharged successfully.Conclusions: Respiratory complications after AADS is prevalent,closely related to the occurrence of adverse in-hospital outcomes,but has no significant effect on long-term prognosis in general.Age,body mass index,smoking history,emphysema,cerebrovascular disease,renal insufficiency,white blood cell count,platelet count,cardiopulmonary bypass time,intraoperative transfusion of red blood cell and platelet were significantly associated with the development of various respiratory complications after AADS.The model established using these predictors performed well in various aspects,which may have clinical utility in early risk assessment and perioperative management.