Eastern Cardiothoracic Surgical Society

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Acute Type A Aortic Dissection Repair 'After-Hours': Does it Influence Outcomes?
Stevan S. Pupovac, MD1, Jonathan M. Hemli, MD2, Karthik Seetharam, MD2, Ashley T. Giammarino, MS2, Jacob Scheinerman, MD2, Alan R. Hartman, MD1, Derek R. Brinster, MD3.
1Department of Cardiothoracic Surgery, North Shore University Hospital / Northwell Health, Queens, NY, USA, 2Department of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital / Northwell Health, Manhattan, NY, USA, 3Department of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital / Northwell Health, New York, Queens, NY, USA.

OBJECTIVE: 'Time of day' has been associated with adverse perioperative outcomes in certain surgical pathologies. Given that acute type A aortic dissection typically mandates immediate repair, irrespective of when it presents, scant attention has been paid to any potential impact of the day/night timing of the operation itself. We sought to determine whether those patients with type A dissection treated during typical 'working hours' demonstrated any difference in outcomes vs. those who required surgery 'after-hours.'
METHODS: Over a 4-year period, 164 consecutive patients underwent primary repair of an acute type A dissection. Based upon the start time of the procedure, patients were divided into 2 groups: 'working hours' (Group 1, 7am - 4pm, Monday to Friday, n = 60), vs. 'after-hours' (Group 2, all other times, including weekends/holidays, n = 104). Intraoperative data and short-term clinical outcomes were analyzed in 53 propensity-matched pairs of patients.
RESULTS: Thirty-day mortality was similar in both groups (Group 1, 6 deaths {11.3%} vs. Group 2, 3 deaths {5.7%}, p = 0.319). Cardiopulmonary bypass, cross-clamp, and circulatory arrest times did not differ between groups. Major perioperative complications were also comparable between groups, including stroke, reoperation for bleeding, deep sternal wound infection, new renal failure, and myocardial infarction.
CONCLUSIONS: Short-term mortality and major morbidity after type A dissection repair are independent of whether the operation is performed during 'working hours' or not. Expeditious surgical intervention is still recommended for all acute dissection, irrespective of time of day.


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