Analysis of risk factors for in-hospital mortality of acute aortic dissection patients after vascular replacement surgery

Ren Jianwei; Xin Yu; Zhang Jianye; Wen Mingxiu; Zhu Guangfa

doi:10.3969/j.issn.1002-1949.2024.05.003

Abstract：Objective To investigate the risk factors of in-hospital mortality in adult patients with acute aortic dissection(AAD)after vascular replacement surgery.Methods From January 2018 to December 2022,complete clinical records of 601 adult patients(aged more than 18 years)diagnosed with AAD from Beijing Anzhen Hospital Affiliated to Capital Medical University were collected for statistical analysis.According to in-hospital outcomes,the patients were divided into survival group(n =532 cases)and death group(n =69 cases).The pre-operative baseline clinical data and relevant variables during and after operation were analyzed by univariate and multivariate Logistic regression analysis for identifying independent risk factors of in-hospital mortality in AAD patients after vascular replacement surgery.Results During the study period,601 adult patients with AAD underwent vascular replacement surgery,including 430 males(71.5%)and 171 females(28.5%),average age was(53.1±12.7)years and body mass index(BMI)was(25.6±4.1)kg/m2,respectively.The results of multivariate Logistic regression analysis showed that the estimated glomerular filtration rate(eGFR,P<0.001),the operation time(P =0.008),the second surgery during hospitalization(P = 0.001),post-operative acute kidney injury(AKI,P =0.030),pulmonary infection(P =0.004),bloodstream infection(P = 0.001)and severe infection(P<0.001),and extracorporeal membrane oxygenation exposure(ECMO,P<0.001)and continuous renal replacement therapy(CRRT,P<0.001)were independent risk factors associated with the in-hospital mortality of AAD patients after vascular replacement surgery.It was also found that patients'age,gender,BMI,the types of AAD,ascending aorta replacement procedure and Bentall + Sun's surgery were not associated with the risk of in-hospital mortality after surgical treatment(P>0.05).The independent risk factors associated with in-hospital mortality in AAD patients after vascular replacement surgery were incorporated in the receiver operating characteristic(ROC)curve analysis,the results showed the area under the ROC curve(AUC)was 0.890(95%CI 0.848-0.932,P<0.001)with 88.9%sensitivity and 68.3%specificity.Conclusions It is important to reduce the mortality and improve short-term and long-term prognosis of high-risk patients by standardized perioperative management and strengthening hospital infection prevention and control measures.