Postoperative neurological complications after emergency repair of acute type A aortic dissection: associations with intensive care resource utilization in a single-center retrospective cohort study

Background: Postoperative neurological complications after emergency repair of acute type A aortic dissection may prolong intensive care unit (ICU) stay, increase intensive care resource use, and elevate bedside nursing capacity requirements. We estimated their incidence and association with workload proxy outcomes and identified factors associated with prolonged ICU length of stay (LOS). Materials and methods: We conducted a single-center retrospective cohort study of consecutive adults undergoing emergency repair at a tertiary hospital between 1 January 2021 and 30 April 2025. Resource-utilization and workload-proxy outcomes were ICU LOS, hospital LOS, and invasive mechanical ventilation (MV) duration in a unit with a fixed 1:1 nurse-to-patient ratio. Prolonged ICU LOS was predefined as ≥10 days and modeled by multivariable logistic regression among hospital survivors. Results: Of 309 adults screened, 274 were included. Postoperative neurological complications occurred in 50 patients (18.2%); stroke occurred in 33 (12.0%). Compared with patients without neurological complications, those with complications had longer ICU LOS (median 11.0 vs 6.0 days; P = 0.004), longer MV duration (238.0 vs 99.5 hours; P < 0.0001), and higher in-hospital mortality (46.0% vs 7.1%; P < 0.001). Among survivors ( n = 235), postoperative acute kidney injury (adjusted odds ratio [aOR] 4.66, 95% confidence interval [CI] 1.87–11.60) and any postoperative neurological complication (aOR 3.16, 95% CI 1.23–8.11) were independently associated with ICU LOS ≥10 days. Conclusion: Postoperative neurological complications occurred in 50 out of 274 patients (18.2%). Among hospital survivors, these complications were associated with 4.9 additional ICU days and 118 additional hours of invasive MV after adjustment, as well as higher odds of a prolonged ICU stay (aOR 3.16, 95% CI 1.23–8.11). Under a fixed 1:1 staffing model, these findings indicate a greater ICU resource-use burden and bedside nursing capacity requirements, warranting confirmation in prospective studies with direct workload measures.