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. 2022 Apr 26;2(3):369-381.
doi: 10.1016/j.jacasi.2021.11.010. eCollection 2022 Jun.

In-Hospital Mortality of Patients With Acute Type A Aortic Dissection Hospitalized on Weekends Versus Weekdays

Toshiyuki Takahashi  1   2 , Hideaki Yoshino  1 , Koichi Akutsu  1 , Tomoki Shimokawa  1 , Hitoshi Ogino  1 , Takashi Kunihara  1 , Michio Usui  1 , Kazuhiro Watanabe  1 , Mitsuhiro Kawata  1 , Hiroshi Masuhara  1 , Manabu Yamasaki  1 , Takeshi Yamamoto  1 , Ken Nagao  1 , Morimasa Takayama  1
Affiliations

In-Hospital Mortality of Patients With Acute Type A Aortic Dissection Hospitalized on Weekends Versus Weekdays

Toshiyuki Takahashi et al. JACC Asia. .

Abstract

Background: In acute aortic dissection, weekend admissions are reported to be associated with increased mortality compared with weekday admissions.

Objective: This study aimed to determine whether patients with acute type A aortic dissection (ATAAD) admitted on weekends had higher in-hospital mortality than those admitted on weekdays in the Tokyo metropolitan area, where we developed a patient-transfer system for aortic dissection.

Methods: Data were collected during the first year after our transfer system began (cohort I) and in the subsequent years from 2013 to 2015 (cohort II).

Results: We studied 2,339 patients (500 in cohort I; 1,839 in cohort II) with ATAAD. Patients with weekend admissions had higher in-hospital mortality than those with weekday admissions in cohort I. In association with increased interfacility transfer during weekends and reduced mortality at non-high-volume centers, the in-hospital mortality in the weekend group improved from 37.2% in cohort I to 22.2% in cohort II (P < 0.001). After inverse probability weighting adjustment, weekend admission was associated with higher in-hospital mortality in cohort I (odds ratio: 2.28; 95% confidence interval: 1.48 to 3.52; P < 0.001), but not in cohort II (odds ratio: 0.96; 95% confidence interval: 0.75 to 1.22; P = 0.731). On multivariable analyses, weekend admission was associated with higher in-hospital mortality in combined cohort I+II; the associations between weekend admission and mortality were not significant in cohort II.

Conclusions: We found a significant reduction in in-hospital mortality in patients with weekend admissions for ATAAD. No mortality difference between weekend and weekday admissions was observed in the later years of the study.

Keywords: AAD, acute aortic dissection; ATAAD, acute type A aortic dissection; CCU, cardiovascular care unit; IMH, intramural hematoma; IPW, inverse probability weighting; TAAS, Tokyo Acute Aortic Super-network; acute aortic dissection; mortality; network; transfer; weekend effect.

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Conflict of interest statement

Data collection and maintenance for the Tokyo CCU network registry is financially supported by the Tokyo Metropolitan Government, which had no role in the execution of this study or the interpretation of the results. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Flow Chart of Patient Selection ATAAD = acute type A aortic dissection.
Figure 2
Figure 2
Annual In-hospital Mortality of Patients Admitted on Weekends Versus Weekdays (A) Overall in-hospital mortality. (B) Surgical in-hospital mortality. During the first year (cohort I), in-hospital mortality was significantly higher in the patients with weekend admissions than in those with weekday admissions. In-hospital mortality did not differ between patients with weekend and weekday admissions during each year in cohort II.
Central Illustration
Central Illustration
Temporal Changes of In-Hospital Mortality in Patients Admitted on Weekends Versus Weekdays The in-hospital mortality of patients with acute type A aortic dissectioin admitted on weekends improved from 37.2% in cohort I to 22.2% in cohort II (P < 0.001), although there was no difference in in-hospital mortality of patients admitted on weekdays between cohort I and cohort II.
See this image and copyright information in PMC

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