Analysis Of Risk Factors Associated With Postoperative Death In 149 Patients With Stanford Type A Aortic Dissection

Objective: To analyze the risk factors associated with postoperative death in patients with Stanford type A aortic dissection,to identify risk factors associated with death,develop relevant rescue targets early to improve the success rate of Stanford type A aortic dissection patients.Methods: A retrospective study of 149 patients with Stanford type A aortic dissection who underwent concurrent surgery at the Fourth Hospital of Hebei Medical University from October 2016 to October 2018 was performed.According to the outcome of the prognosis,the patients were divided into the death group(42 cases)and the survival group(107 cases).Retrospectively through medical record review,telephone return visit,collect all patientrelated clinical case data and prognosis results.Including pre-operative general information: gender,age,BMI,morbidity,past medical history,etc.,surgical related data: extracorporeal circulation time,auxiliary time,blood transfusion,etc.,postoperative related indicators: postoperative test indicators,acute physiology and chronic Health score(APACHE II)score,sequential organ failure estimated score(SOFA score),ICU time,mechanical ventilation time,postoperative complications,secondary surgery reasons and other possible risk factors.Based on the results of the two groups of patients,the data between the two groups were selected for univariate analysis to determine the presence of potential risk factors.Multivariate and bivariate logistic regression analysis was performed according to the statistically significant differences,and the independent risk factors for surgical death were determined.Results: A total of 149 patients with Stanford type A aortic dissection were enrolled in the study,with 42 deaths and a mortality rate of 28.18%.1.The results of single factor analysis of this study showed that preoperative general conditions related indicators: overweight,body mass index(BMI)≥ 25(P = 0.002)were risk factors for postoperative death,but failed to obtain age(P = 0.304),gender(P = 0.734),past disease and other factors to increase the risk of death after Stanford type A aortic dissection.Intraoperative related factors: operation time(P<0.001),extracorporeal circulation time(P<0.001),extracorporeal circulation time(P<0.001),total intraoperative red blood cell transfusion(P=0.016),etc.Increased risk of death.There was no significant correlation between surgical options and poor prognosis.Patients with postoperative APACHE II score and SOFA score were significantly higher in the death group than in the survival group(P < 0.001).Postoperative low cardiac output(P < 0.001),acute kidney injury(AKI)(P < 0.001),postoperative hypoxemia Symptoms(P=0.009),postoperative disseminated intravascular coagulation(DIC)(P<0.001),and liver failure(P<0.001)were associated with poor prognosis.There was a statistically significant difference between the two groups in postoperative ICU time(P < 0.001).2.The results of single factor analysis of survival group and death group were analyzed by logistic regression analysis: patients were overweight(OR: 7.520,P=0.020),SOFA score>8 points(OR: 12.795,P<0.001),assisted extracorporeal circulation time> 70 minutes(OR: 5.779,P = 0.012),patients with low cardiac output(OR: 4.972,P = 0.014),postoperative patients with DIC(OR: 9.989,P = 0.021)for acute type A aortic dissection Independent risk factors for postoperative mortality.Conclusions: The independent risk factors for death after type A aortic dissection in this study were: overweight,SOFA score > 8 points,stop circulation assist time greater than 70 minutes,postoperative low cardiac output,postoperative DIC.Intraoperative blood transfusion,postoperative liver failure,and AKI are associated with an increased risk of death,but are not independent risk factors for death.