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- Title:
Time of day does not influence outcomes in acute type A aortic dissection: Results from the IRAD.
- Document type:
- Journal Article
- Author(s):
- Arnaoutakis, George; Bianco, Valentino; Estrera, Anthony L; Brinster, Derek R; Ehrlich, Marek P; Peterson, Mark D; Bossone, Eduardo; Myrmel, Truls; Pacini, Davide; Montgomery, Daniel G; Eagle, Kim A; Bekeredijan, Raffi; Shalhub, Sherene; De Vincentiis, Carlo; Chad Hughes, G; Chen, Edward P; Eckstein, Hans-Henning; Nienaber, Christoph A; Sultan, Ibrahim
- Abstract:
- BACKGROUND: Type A acute aortic dissection (TAAAD) represents a surgical emergency requiring intervention regardless of time of day. Whether such a "evening effect" exists regarding outcomes for TAAAD has not been previously studied using a large registry data. METHODS: Patients with TAAAD were identified from the International Registry of Acute Aortic Dissections (1996-2019). Outcomes were compared between patients undergoing operative repair during the daytime (D), defined as 8 am-5 pm, versus the evening (N), defined as 5 pm-8 am. RESULTS: Four thousand one-hundrd and ninety-seven surgically treated patients with TAAAD were identified, with 1824 patients undergoing daytime surgery (43.5%) and 2373 patients undergoing evening surgery (56.5%). Daytime patients were more likely to have undergone prior cardiac surgery (13.2% vs. 9.5%; p < .001) and have had a prior aortic dissection (4.8% vs. 3.4%; p = .04). Evening patients were more likely to have been transferred from a referring hospital (70.8% vs. 75.0%; p = .003). Daytime patients were more likely to undergo aortic valve sparing root procedures (23.3% vs. 19.2%; p = .035); however, total arch replacement was performed with equal frequency (19.4% vs. 18.8%; p = .751). In-hospital mortality (D: 17.3% vs. N. 16.2%; p = .325) was similar between both groups. Subgroup analysis examining the effect of weekend presentation revealed no significant mortality difference. CONCLUSIONS: A majority of TAAAD patients underwent surgical repair at night. There were higher rates of postoperative tamponade in evening patients; however, mortality was similar. The expertise of cardiac-dedicated operative and critical care teams regardless of time of day as well as training paradigms may explain similar mortality outcomes in this high risk population.
- Journal title abbreviation:
- J Card Surg
- Year:
- 2020
- Journal volume:
- 35
- Journal issue:
- 12
- Pages contribution:
- 3467-3473
- Fulltext / DOI:
- doi:10.1111/jocs.15017
- Pubmed ID:
- http://view.ncbi.nlm.nih.gov/pubmed/32939836
- Print-ISSN:
- 0886-0440
- TUM Institution:
- Fachgebiet Gefäßchirurgie (Prof. Eckstein)
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