Analysis on the influencing factors of postoperative delirium after off-pump coronary artery bypass grafting based on generalized additive model
10.3969/j.issn.1671-8348.2025.10.030
- VernacularTitle:基于广义相加模型的非体外循环冠状动脉搭桥术后谵妄的影响因素分析
- Author:
Ye HE
1
;
Wei WANG
;
Jiefang SHEN
Author Information
1. 上海交通大学医学院附属瑞金医院手术室,上海 200025
- Keywords:
generalized additive model;
delirium;
nonlinear;
off-pump coronary artery bypass grafting
- From:
Chongqing Medicine
2025;54(10):2407-2413
- CountryChina
- Language:Chinese
-
Abstract:
Objective Based on the generalized additive model(GAM),this study comprehensively ana-lyzes the nonlinear relationships between various factors and postoperative delirium after off-pump coronary artery bypass grafting(OPCAB),aiming to establish an early warning identification model and provide a theo-retical basis for developing corresponding intervention measures.Methods A total of 431 patients who under-went OPCAB surgery in the Department of Cardiac Surgery of this hospital were selected,and their cross-sec-tional study data were collected.Postoperative delirium was assessed using the confusion assessment method for the intensive care unit(CAM-ICU).Based on the assessment results,patients were divided into the deliri-um group and the non-delirium group.Linear models were used for fitting to determine the association be-tween variables and postoperative delirium.Lasso logistic regression model was employed to screen for varia-bles which significantly associated with postoperative delirium.The GAM was further used to analyze and cap-ture the relationships between the relevant variables and postoperative delirium.Results Statistically signifi-cant differences(P＜0.05)were observed between the delirium group and the non-delirium group in terms of age,preoperative albumin level,preoperative N-terminal pro-B-type natriuretic peptide(NT-proBNP),preop-erative left ventricular ejection fraction(LVEF),preoperative glycated hemoglobin(HbA1c),duration of me-chanical ventilation,ICU stay,preoperative comorbidities(peripheral vascular disease,diabetes,anemia,pe-ripheral vascular disease),intraoperative blood transfusion,and postoperative electrolyte disturbances.The Lasso regression analysis identified curved relationships(P＜0.05)between postoperative delirium and age,preoperative HbA1c,preoperative peripheral vascular disease,and postoperative electrolyte disturbances.The GAM results further confirmed the curved relationships of age,preoperative HbA1c,preoperative peripheral vascular disease,and postoperative electrolyte disturbances with postoperative delirium(P＜0.05).Saturation effects were observed for age and preoperative HbA1c,while positive associations were found for preoperative peripheral vascular disease and postoperative electrolyte disturbances.Conclusion Age and HbA1c exhibit curved relationships with postoperative delirium after OPCAB,and exhibit saturation effects.Preoperative pe-ripheral vascular disease and postoperative electrolyte disturbances show positive curved relationships with postoperative delirium after OPCAB.
