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Time of day does not influence outcomes in acute type A aortic dissection: Results from the IRAD.

Time of day does not influence outcomes in acute type A aortic dissection: Results from the IRAD.

Authors :
Arnaoutakis G
Bianco V
Estrera AL
Brinster DR
Ehrlich MP
Peterson MD
Bossone E
Myrmel T
Pacini D
Montgomery DG
Eagle KA
Bekeredijan R
Shalhub S
De Vincentiis C
Chad Hughes G
Chen EP
Eckstein HH
Nienaber CA
Sultan I
Source :
Journal of cardiac surgery [J Card Surg] 2020 Dec; Vol. 35 (12), pp. 3467-3473. Date of Electronic Publication: 2020 Sep 16.
Publication Year :
2020

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.<br />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.<br />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.<br />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.<br /> (© 2020 Wiley Periodicals LLC.)

Details

Language :
English
ISSN :
1540-8191
Volume :
35
Issue :
12
Database :
MEDLINE
Journal :
Journal of cardiac surgery
Publication Type :
Academic Journal
Accession number :
32939836
Full Text :
https://doi.org/10.1111/jocs.15017