Construction of a nomogram prediction model for postoperative delirium after thoracoscopic surgery under general anesthesia with cardiopulmonary bypass

Liu Lin; Bai Yana; He Weiyi; Ma Yanli; Zhou Jun; Liu Tong; Xu Baoling

doi:10.11986/j.issn.1673-873X.2025.05.12

Abstract：Objective To explore the risk factors for postoperative delirium after thoracoscopic surgery under general anesthesia with cardiopulmonary bypass and to construct a nomogram prediction model.Methods This study selected 302 patients who underwent thoracoscopic surgery under general anesthesia with cardiopulmonary bypass at the First Affiliated Hospital of Air Force Medical University from May 2020 to December 2023 as the research participants.Based on the presence or absence of postoperative delirium,patients were allocated to a delirium group(n=73)and a non-delirium group(n=229).Multivariate logistic regression analysis was used to explore the influencing factors of postoperative delirium in these patients,and based on this,a nomogram model was constructed.The receiver operating characteristic(ROC)curve was used to evaluate the predic-tive value of the nomogram model for postoperative delirium in patients undergoing thoracoscopic surgery under general anes-thesia with cardiopulmonary bypass.Results The proportions of patients aged ≥60 years,with comorbid diabetes,cardiac function class Ⅲ-Ⅳ,postoperative use of sedative medications,and postoperative hypotension were greater in the delirium group than in the non-delirium group;duration of mechanical ventilation,cardiopulmonary bypass time,and aortic cross-clamp time were longer in the delirium group than in the non-delirium group;the Acute Physiology and Chronic Health Evaluation(APACHE Ⅱ)score was higher in the delirium group than in the non-delirium group,and the albumin level was lower in the delirium group than in the non-delirium group;all these differences were statistically significant(P＜0.05).Age ≥60 years(OR=1.956,95％CI:1.383-2.767),longer cardiopulmonary bypass time(OR=2.063,95％CI:1.461-2.912),longer aortic cross-clamp time(OR=3.019,95％CI:1.939-4.702),higher APACHE Ⅱ score(OR=2.319,95％CI:1.582-3.398),postoperative hypotension(OR=2.392,95％CI:1.613-3.546),and albumin level has not decreased(OR=0.392,95％CI:0.261-0.590)were influence factors for postoperative delirium in patients undergoing thoracoscopic surgery under general anesthesia with cardiopulmonary bypass(P＜0.05).A nomogram model for predicting postoperative delirium in these patients was established.The results showed that the concordance index(C-index)was 0.876(95％CI:0.824-0.928).Deci-sion curve analysis results indicated that when the threshold probability was＞0.05,the net benefit rate for postoperative delir-ium in these patients was＞0.The area under the curve(AUC)(95％CI)of the nomogram model for predicting postopera-tive delirium among these patients was 0.883(0.831-0.935),with a specificity of 67.92％and a sensitivity of 91.74％.Con-clusion Influence factors for postoperative delirium in patients undergoing thoracoscopic surgery under general anesthesia with cardiopulmonary bypass include age,cardiopulmonary bypass time,aortic cross-clamp time,postoperative APACHE Ⅱ score,postoperative hypotension,and postoperative albumin.The nomogram model constructed based on these factors has high predictive value for postoperative delirium.