Single-center retrospective cohort at China Medical University Hospital (Taichung, Taiwan) using fully de-identified electronic health records. Consecutive adults who underwent emergency repair of acute type A aortic dissection between 2021-01-01 and 2025-04-30 were pooled into one cohort. The study measures the incidence and patterns of early postoperative neurological complications and evaluates their association with intensive care unit (ICU) resource use, focusing on prolonged ICU length of stay (LOS ≥ 10 days), ICU and hospital LOS, and duration of mechanical ventilation (MV). No new data collection or patient contact occurs. Institutional Review Board (IRB) approval: CMUH114-REC1-139.
Adults (≥ 18 years) undergoing emergency repair for acute type A aortic dissection (ATAAD) at China Medical University Hospital (CMUH) during 2021-01-01 to 2025-04-30 were screened. Exclusions: missing key variables, preoperative stroke within 30 days or modified Rankin Scale (mRS) ≥ 4, pregnancy. The analytic cohort included 274 of 309 screened patients. Neurological complications comprise radiology-confirmed stroke, other focal neurological deficits, paraplegia, or sustained coma/encephalopathy recorded by neurology consultation. Prolonged ICU stay is prespecified as ICU LOS ≥ 10 days in the index admission. Outcomes: primary outcomes are prolonged ICU stay and any postoperative neurological complication; secondary outcomes are ICU LOS (days), duration of mechanical ventilation (hours), hospital LOS (days), in-hospital mortality, and in-hospital death within 30 days of the index surgery. Analyses are performed in R version 4.5.1. Continuous variables are summarized as medians with interquartile ranges (IQRs) and compared using the Mann-Whitney U test; categorical variables are presented as counts and percentages and compared using chi-square or Fisher exact tests. Multivariable logistic regression identifies factors associated with prolonged ICU stay (ICU LOS ≥ 10 days) among hospital survivors using a priori covariates (age, sex, chronic kidney disease stage 4-5, operation time, cardiopulmonary bypass \[CPB\] time, intraoperative red blood cell \[RBC\] units transfused, postoperative acute kidney injury \[AKI\], any postoperative neurological complication). A prespecified sensitivity analysis in the full cohort treats the endpoint as ICU LOS ≥ 10 days or in-hospital death using the same prespecified covariates. Data were de-identified before analysis and stored on secure hospital servers; the study is minimal risk and does not involve United States Food and Drug Administration (US FDA) regulated products.
Study Type
OBSERVATIONAL
Enrollment
274
China Medical University Hospital
Taichung, Taichung City, Taiwan
Prolonged ICU length of stay (LOS ≥10 days)
Proportion of participants with ICU LOS ≥10 days during the index ICU admission. Unit of measure: percent.
Time frame: Through ICU discharge during the index admission (up to 30 days).
Any postoperative neurological complication
Proportion with stroke (CT/MRI confirmed), other focal neurological deficits, paraplegia, or sustained coma/encephalopathy recorded by neurology consultation. Unit of measure: percent.
Time frame: Through hospital discharge during the index admission (up to 30 days).
ICU length of stay (days)
ICU LOS summarized as median and IQR; larger values indicate greater resource use. Unit of measure: days.
Time frame: Through ICU discharge during the index admission (up to 30 days).
Duration of mechanical ventilation (hours)
Cumulative hours of invasive ventilation from ICU arrival to final extubation. Unit of measure: hours.
Time frame: Through final extubation during the index hospitalization (up to 40 days).
Hospital length of stay (days)
Days from hospital admission to discharge; deaths counted up to date of death. Unit of measure: days.
Time frame: Through hospital discharge during the index admission (up to 65 days).
In-hospital mortality
All-cause death before discharge from the index hospitalization. Unit of measure: percent.
Time frame: Through hospital discharge during the index admission (up to 30 days).
In-hospital mortality within 30 days
All-cause death occurring during the index hospitalization within 30 days after the index surgery (deaths after hospital discharge were not captured).
Time frame: Up to 30 days after index surgery, during the index hospitalization.
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