Transient advanced mental impairment: an underappreciated morbidity after aortic surgery.
OBJECTIVE
To determine the incidence, risk factors, and associated morbidity of transient advanced mental impairment (TAMI) after aortic surgery.


METHODS
We retrospectively studied the charts of 188 consecutive patients undergoing elective aortic reconstruction during a recent 6-year period at a university hospital. All patients were lucid on admission and nonintubated at the time of evaluation at least 2 days after operation. TAMI was defined as disorientation or confusion on 2 or more postoperative days. Preoperative, intraoperative, and postoperative clinical variables were examined statistically for associations with TAMI.


RESULTS
Fifty-three patients (28%) had development of TAMI 3.9 plus minus 2.8 days after operation. Stepwise logistic regression analysis selected the following independent predictors for TAMI: age >65 years (odds ratio [OR], 7.9; 95% confidence interval [CI], 2.7 to 23.7), American Society of Anesthesiology physical status classification >3 (OR, 2.8; 95% CI, 1.3 to 5.9), diabetes mellitus (OR, 3.4; 95% CI, 1.2 to 9.8), old myocardial infarction (OR, 2.4; 95% CI, 1.1 to 5.3), and hypertension (OR, 2.3; 95% CI, 1.0 to 5.3). Alcohol consumption was not significantly associated with TAMI. In the postoperative period, patients with TAMI were more likely to have hypoxia (P <.001), a need for reintubation (P <.001), pneumonia (P <.001), congestive heart failure (P =.003), and kidney failure (P =.05). In addition, patients with TAMI had a longer duration of endotracheal intubation (3.7 plus minus 7.8 vs 0.6 plus minus 1.2 days, P <.001), stay in the intensive care unit (8.9 plus minus 9 vs 3.9 plus minus 2 days, P <.001), and postoperative hospital stay (14.8 plus minus 11 vs 9.2 plus minus 5 days, P <.001) than patients without TAMI. Twenty (38%) patients with TAMI were discharged to intermediate-care facilities, compared with 11 (8%) patients without TAMI (P <.001). Postoperative variables conferring the largest relative risks for development of TAMI included oxygen saturation less than 92% (5.4), the need for reintubation (3.3), congestive heart failure (3.3), and pneumonia (3.2). TAMI, conversely, conferred the largest relative risks for development of postoperative congestive heart failure (15.3), the need for reintubation (9.3), pneumonia (7.1), and the need for ICU readmission (3.8).


CONCLUSIONS
These data show that TAMI is prevalent among patients undergoing aortic reconstruction and is associated with dramatically increased morbidity and postoperative hospitalization rates.
Rosen
Scott F
SF
Division of Vascular Surgery, University of Texas Southwestern Medical Center, Dallas 75390-9157, USA.
Clagett
G Patrick
GP
Valentine
R James
RJ
Jackson
Mark R
MR
Modrall
J Gregory
JG
McIntyre
Kenneth E
KE
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000601:surgery; D001927:Brain Diseases / Q000453:epidemiology / Q000209:etiology; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D010359:Patient Readmission; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects