Factors Related to Hospitalisation-Associated Disability in Patients after Surgery for Acute Type A Aortic Dissection: A Retrospective Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Definition of HAD
2.3. Postoperative Cardiac Rehabilitation
2.4. Additional Assessments
2.5. Statistical Analysis
3. Results
4. Discussion
4.1. The Progression of Cardiac Rehabilitation after ATAAD Surgery
4.2. Factors Associated with HAD
4.3. Study Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Overall | Non-HAD | HAD | p Value | |
---|---|---|---|---|
(n = 483) | (n = 379) | (n = 104) | ||
Age, years | 69 (59–78) | 68 (58–75) | 78 (66–83) | <0.001 |
Female, n (%) | 250 (51.8) | 187 (49.3) | 63 (60.6) | <0.05 |
BMI, kg/m2 | 23.6 (21.3–26.3) | 23.7 (21.4–26.4) | 23.1 (21.2–26.0) | 0.62 |
Comorbidity, n (%) | ||||
Hypertension | 336 (69.6) | 260 (68.6) | 76 (73.1) | 0.38 |
Dyslipidaemia | 93 (19.3) | 71 (18.7) | 22 (21.2) | 0.58 |
Diabetes | 25 (5.2) | 17 (4.5) | 8 (7.7) | 0.19 |
Chronic kidney disease | 24 (5.0) | 17 (4.5) | 7 (6.7) | 0.35 |
Coronary artery disease | 21 (4.3) | 16 (4.2) | 5 (4.8) | 0.49 |
Chronic obstructive pulmonary disease | 8 (1.7) | 6 (1.6) | 2 (1.9) | 0.54 |
Blood biochemistry | ||||
Haemoglobin, g/dL | 12.3 (11.1–13.8) | 12.5 (11.2–14.0) | 11.6 (10.2–12.7) | <0.001 |
Platelet, 103/μL | 164 (132–200) | 165 (132–202) | 161 (133–194) | 0.53 |
Creatinine, mg/dL | 0.87 (0.70–1.12) | 0.86 (0.69–1.12) | 0.91 (0.75–1.13) | 0.15 |
Albumin, g/dL | 3.6 (3.3–4.0) | 3.7 (3.4–4.0) | 3.4 (3.0–3.7) | <0.001 |
CRP, mg/dL | 0.15 (0.04–0.99) | 0.13 (0.04–0.90) | 0.18 (0.05–1.40) | 0.38 |
Aortic surgery, n (%) | 0.40 | |||
Ascending aortic replacement | 255 (51.6) | 187 (49.2) | 68 (59.6) | |
Hemi arch replacement | 26 (5.3) | 18 (4.7) | 8 (7.0) | |
Total arch replacement | 135 (27.3) | 112 (29.5) | 23 (20.2) | |
Concomitant | 78 (15.8) | 63 (16.6) | 15 (13.2) | |
Operation time, min | 225 (185–287) | 225 (182–285) | 229 (193–304) | 0.21 |
Cardiopulmonary bypass time, min | 128 (105–168) | 128 (104–168) | 128 (110–169) | 0.54 |
Circulatory arrest time, min | 27 (22–38) | 27 (21–39) | 28 (23–38) | 0.42 |
IMV time, h | 22.9 (18.2–34.6) | 22.1 (17.7–30.9) | 31.6 (21.8–46.3) | <0.001 |
Bleeding, ml | 220 (150–350) | 210 (150–320) | 250 (163–438) | <0.05 |
APACHE II score, points | 15 (12–18) | 15 (12–18) | 16 (13–18) | <0.05 |
NPPV, n (%) | 102 (21.1) | 67 (17.7) | 35 (33.7) | <0.001 |
CRRT, n (%) | 12 (2.5) | 6 (1.6) | 6 (5.8) | <0.05 |
Acute kidney injury, n (%) | 175 (36.2) | 130 (34.3) | 45 (43.3) | 0.09 |
Delirium, n (%) | 123 (25.5) | 71 (18.7) | 52 (50.0) | <0.001 |
Distal enlargement, n (%) | 34 (7.0) | 26 (6.7) | 8 (7.7) | 0.77 |
ICU stay, days | 3 (2–5) | 3 (2–4) | 4 (3–7) | <0.001 |
Hospital stay, days | 14 (11–21) | 14 (11–21) | 13 (10–22) | 0.50 |
Cardiac rehabilitation, days | ||||
Sitting | 2 (1–2) | 2 (1–2) | 2 (2–3) | <0.001 |
Standing | 2 (1–3) | 2 (1–2) | 2 (2–3) | <0.001 |
Walking | 3 (3–4) | 3 (2–4) | 5 (3–7) | <0.001 |
Barthel index, points | ||||
Preoperative | 100 (100–100) | 100 (100–100) | 100 (100–100) | 0.40 |
Discharge | 100 (100–100) | 100 (100–100) | 80 (55–90) | <0.001 |
Home discharge, n (%) | 276 (57.1) | 255 (67.3) | 21 (20.2) | <0.001 |
n = 131 | |
---|---|
Not awakening | 51 (38.9) |
Respiratory-related | 26 (19.8) |
Sedation | 14 (10.7) |
Uncontrolled blood pressure | 10 (7.6) |
Arrhythmia | 8 (6.1) |
Acute kidney injury | 6 (4.6) |
Pain distress | 5 (3.8) |
Active bleeding | 4 (3.1) |
Acute limb ischemia | 2 (1.5) |
Others | 5 (3.8) |
Walking Onset Category | |||
---|---|---|---|
Early | Usual | Delayed | |
(n = 111) | (n = 243) | (n = 129) | |
Age, years | 66 (55–75) | 71 (62–79) 1 | 69 (57–81) |
Female, n (%) | 48 (43.2) | 137 (56.4) | 65 (50.4) |
BMI, kg/m2 | 23.4 (21.3–25.6) | 23.7 (21.5–26.4) | 23.1 (20.9–26.6) |
Comorbidity, n (%) | |||
Hypertension | 79 (71.2) | 170 (70.0) | 87 (67.4) |
Dyslipidemia | 22 (19.8) | 50 (20.6) | 21 (16.3) |
Diabetes | 4 (3.6) | 15 (6.2) | 6 (4.7) |
Chronic kidney disease | 3 (2.7) | 11 (4.5) | 10 (7.8) |
Coronary artery disease | 2 (1.8) | 12 (4.9) | 7 (5.4) |
Chronic obstructive pulmonary disease | 3 (2.7) | 3 (1.2) | 2 (1.6) |
Operation time, min | 215 (184–280) | 218 (180–268) | 263 (197–324) 1,2 |
Cardiopulmonary bypass time, min | 123 (102–165) | 125 (103–157) | 149 (110–192) 1,2 |
IMV time, h | 19.3 (16.4–23.7) | 22.6 (18.0–30.5) 1 | 38.1 (22.2–50.7) 1,2 |
Bleeding, ml | 200 (130–270) | 220 (150–350) | 280 (165–453) 1,2 |
APACHE II score, points | 14 (12–17) | 15 (13–17) | 15 (13–19) 1 |
NPPV, n (%) | 8 (7.2) | 42 (17.3) | 52 (40.3) 3 |
CRRT, n (%) | 1 (0.9) | 2 (0.8) | 9 (7.0) 3 |
Delirium, n (%) | 11 (9.9) | 58 (23.9) | 54 (41.9) 3 |
ICU stay, days | 2 (1–2) | 3 (2–3) 1 | 5 (4–8) 1,2 |
Hospital stay, days | 13 (10–18) | 14 (11–20) | 19 (13–28) 1,2 |
Preoperative BI, points | 100 (100–100) | 100 (100–100) | 100 (100–100) |
Univariate | Multivariate | |||||
---|---|---|---|---|---|---|
OR | 95% CI | p Value | OR | 95% CI | p Value | |
Age [every 1-year increase] | 1.05 | 1.03–1.08 | <0.001 | 1.05 | 1.02–1.09 | <0.01 |
<60 years | 1.00 | 1.00 | ||||
60–69 years | 0.75 | 0.36–1.57 | 0.45 | |||
70–79 years | 1.38 | 0.71–2.67 | 0.35 | |||
≥80 years | 4.83 | 2.56–9.12 | <0.001 | 4.28 | 1.62–11.35 | <0.01 |
Female | 1.58 | 1.01–2.45 | <0.05 | |||
Albumin [every 1 g/dL increase] | 0.37 | 0.23–0.58 | <0.001 | |||
Haemoglobin [every 1 g/dL increase] | 0.76 | 0.67–0.86 | <0.001 | |||
APACHE II score [every 1-point increase] | 1.05 | 1.00–1.11 | 0.07 | |||
IMV time [every 1-h increase] | 1.03 | 1.02–1.05 | <0.001 | |||
NPPV | 2.36 | 1.46–3.84 | <0.01 | 2.15 | 1.10–4.19 | <0.05 |
CRRT | 3.81 | 1.20–12.1 | <0.05 | |||
Delirium | 4.34 | 2.73–6.89 | <0.001 | 2.93 | 1.60–−5.37 | <0.01 |
ICU stay (every 1-day increase) | 1.28 | 1.18–1.39 | <0.001 | |||
Walking (every 1-day increase) | 1.37 | 1.23–1.54 | <0.001 | 1.29 | 1.07–1.56 | <0.01 |
Univariate | Multivariate * | |||||
---|---|---|---|---|---|---|
OR | 95% CI | p Value | OR | 95% CI | p Value | |
Walking start category | ||||||
Early | 1.00 | 1.00 | ||||
Usual | 1.97 | 0.91–4.25 | 0.08 | 0.97 | 0.42–2.26 | 0.94 |
Delayed | 9.55 | 4.45–20.52 | <0.001 | 2.76 | 1.05–7.21 | <0.05 |
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Hirakawa, K.; Nakayama, A.; Saitoh, M.; Hori, K.; Shimokawa, T.; Iwakura, T.; Haraguchi, G.; Isobe, M. Factors Related to Hospitalisation-Associated Disability in Patients after Surgery for Acute Type A Aortic Dissection: A Retrospective Study. Int. J. Environ. Res. Public Health 2022, 19, 12918. https://doi.org/10.3390/ijerph191912918
Hirakawa K, Nakayama A, Saitoh M, Hori K, Shimokawa T, Iwakura T, Haraguchi G, Isobe M. Factors Related to Hospitalisation-Associated Disability in Patients after Surgery for Acute Type A Aortic Dissection: A Retrospective Study. International Journal of Environmental Research and Public Health. 2022; 19(19):12918. https://doi.org/10.3390/ijerph191912918
Chicago/Turabian StyleHirakawa, Kotaro, Atsuko Nakayama, Masakazu Saitoh, Kentaro Hori, Tomoki Shimokawa, Tomohiro Iwakura, Go Haraguchi, and Mitsuaki Isobe. 2022. "Factors Related to Hospitalisation-Associated Disability in Patients after Surgery for Acute Type A Aortic Dissection: A Retrospective Study" International Journal of Environmental Research and Public Health 19, no. 19: 12918. https://doi.org/10.3390/ijerph191912918