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. 2021 May 5:7:12-20.
doi: 10.1016/j.xjon.2021.04.017. eCollection 2021 Sep.

Outcomes of acute type A aortic dissection repair: Daytime versus nighttime

Amer Harky  1   2   3 , Sabrina Mason  2 , Ahmed Othman  1 , Matthew Shaw  1   3 , Omar Nawaytou  1 , Deborah Harrington  1 , Manoj Kuduvalli  1 , Mark Field  1   2   3
Affiliations

Outcomes of acute type A aortic dissection repair: Daytime versus nighttime

Amer Harky et al. JTCVS Open. .

Abstract

Objective: We sought to report our experience of repairing acute type A aortic dissection (ATAAD) over 21 years during in-hours versus out-of-hours before and after the establishment of specialized aortic service and rota.

Methods: A retrospective analysis of all patients who had ATAAD repair between November 1998 and December 2019 in our center. In-hours were defined as 08:00 to 19:59 hours and out of hours were defined as 20:00 to 07:59 hours.

Results: A total of 286 patients underwent repair of ATAAD. Eighty operations took place during the prerota period (43 operations in hours, 37 out of hours) and 206 operations during the specialized rota period (110 in hours, 96 out of hours). There was no difference in 30-day mortality between the in-hours and out-of-hours groups in either the prerota (23.3% vs 32.4%; P = .36) or specialized rota periods (11.6% vs 11.5%; P = .94). Mean number of cases per year increased by 83% between the prerota and specialized rota periods. Thirty-day mortality reduced in both the in-hours (23.3% vs 11.6%) and out-of-hours (32.4% vs 11.5%) groups since introduction of the specialized aortic rota.

Conclusions: Outcomes in repair of ATAAD during in-hours and out-of-hours periods are similar when operated on in a specialized unit with a dedicated aortic team. This emphasizes the current global trend of service centralization without particular attention to time of day to operate on such critical cohort patients.

Keywords: ATAAD, acute type A aortic dissection; CVA, cerebrovascular accident; ICU, intensive care unit; IRAD, International Registry of Acute Aortic Dissections; SAR, specialized aortic rota; TIA, transient ischemic attack; aorta; dissection; outcomes; timing of surgery.

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Figures

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Graphical abstract
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Case distribution between prerota times and specialized aortic rota.
Figure 1
Figure 1
Reported outcomes for patients who underwent repair of acute type A aortic dissection during in hours (8:00 am-7:59 pm) versus out of hours (8:00 pm-7:59 am) during prerota times (October 1998-September 2007) and within the specialized aortic rota times (between October 2007 and December 2019). There was no difference in stroke and 30-day mortality rate between in-hours and out-of-hours surgery.
Figure 2
Figure 2
Case distribution between prerota times and specialized aortic rota.
Figure E1
Figure E1
Panel chart showing increase in activity of acute type A aortic dissection repair and reduction in 30-day mortality.
See this image and copyright information in PMC

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