All patients who underwent aortic dissection from 2011 to 2015 were screened. A total of 845 operation records were extracted from the database. Three hundred twenty-eight patients were excluded because the type of surgery did not meet the inclusion criteria. Twenty-two patients were excluded due to the lack of postoperative platelet count or loss to follow-up. Hence, a total of 495 patients were included in the analysis. The screening process and results are shown in Fig. 1.
Among all 495 patients, the mean age was 47.5 ± 10.7 years, and there were 110 females and 385 males. All patients were followed up for more than three years after surgery. In addition, the 3-year survival rate was 91.3%. In terms of preoperative indicators, there were no statistically significant differences between the two groups in BMI, time from onset to admission, preoperative complications, NYHA grading, preoperative ultrasound, preoperative WBC count, or HB count. However, there were statistical differences in sex, age, platelet count and other aspects between the two groups. The preoperative information of the patients is shown in Table 1.
However, intraoperative indexes showed no statistically significant differences between the two groups in intraoperative combined operation type, blood loss, plasma and platelet infusion volume or clamping time. The P value of the two groups was less than 0.05 for the amount of red blood cell infusion and cardiopulmonary bypass (CPB) time, showing a statistical difference.
Among all enrolled patients, the in-hospital mortality rate was 8.28%. The median postoperative hospital stay was 12 days (IQR 9–16), and the median postoperative ICU stay was 48 h (IQR 33–88). There were 18 patients (3.64%) who underwent reoperation for hemorrhage after surgery, and 26 patients (5.25%) who underwent reoperation for other reasons. In terms of postoperative complications, there were 8 (1.62%) patients with cardiac dysfunction and 108 (21.82%) patients with central nervous system complications. The incidence of respiratory complications was 24.24%, and that of digestive complications was 33.74%. Postoperative data are shown in Table 2.
In the univariate logistic regression analysis, preoperative and intraoperative factors were analyzed, and factors with a P value < 0.1 were included in multivariate logistic regression. The results of univariate Logistic regression are shown in Additional file 1: table 2.
In the first step of multifactor regression, a total of 13 factors were put into the regression, including age, sex, CPB duration, red blood cell (RBC) infusion, fresh frozen plasma (FFP) infusion, postoperative platelet count, reoperation for hemostasis, reoperation for other reasons, readmission to the ICU, postoperative cardiac insufficiency, postoperative CNS complications, postoperative complications of the respiratory system, and postoperative infection. The backward-stepwise logistic regression method was used in multivariate regression, and in every step, factors whose P value was not less than 0.1 were removed from the regression model. After correction for confounding factors, postoperative platelet count remained an independent factor that was associated with lower mortality (OR = 0.918, 95% CI 0.853–0.988, P = 0.023) (Table 3). Other factors remaining in the logistic regression model were sex (OR = 3.213, P = 0.005), CPB duration (OR = 1.008, P = 0.012), readmission to the ICU (OR = 3.751, P = 0.041), postoperative cardiac insufficiency (OR = 13.614, P = 0.006), postoperative CNS complications (OR = 2.986, P = 0.004) and postoperative complications of the respiratory system (OR = 3.976, P < 0.001).
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