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. 2024 Mar;54(3):126-137.
doi: 10.4070/kcj.2023.0266. Epub 2024 Jan 18.

Off-hours Surgery and Mortality in Patients With Type A Aortic Dissection Repair: A Systematic Review and Meta-Analysis

Peter Pin-Sung Liu  1   2 , Jui-Chih Chang  3   4 , Jin-Yi Hsu  5   6 , Huei-Kai Huang  6   7   8 , Ching-Hui Loh  1   5 , Jih-I Yeh  1   6   9
Affiliations

Off-hours Surgery and Mortality in Patients With Type A Aortic Dissection Repair: A Systematic Review and Meta-Analysis

Peter Pin-Sung Liu et al. Korean Circ J. 2024 Mar.

Abstract

Background and objectives: The impact of off-hours admission (such as weekends, nighttime, and non-working hours) vs. regular hours (weekdays and daytime working hours) on the mortality risk of patients undergoing surgery for type A aortic dissection (TAAD) repair is still uncertain. To address this uncertainty, we undertook a comprehensive systematic review and meta-analysis. We aimed to assess the potential link between off-hours admission and the risk of mortality in patients undergoing TAAD repair surgery.

Methods: We conducted a thorough search of the PubMed, Embase, and Cochrane Library databases, covering the period from their inception to May 20, 2023. Our inclusion criteria encompassed all studies that examined the potential relationship between off-hour admission and mortality in individuals who had undergone surgery for TAAD repair. The odds ratios (ORs) were extracted and combined utilizing a random effects model for our synthesis.

Results: Nine studies with 16,501 patients undergoing TAAD repair surgery were included in the meta-analysis. Overall, patients who underwent surgery during the weekend had higher in-hospital mortality (pooled OR, 1.41; 95% confidence interval [CI], 1.14-1.75; p=0.002) than those treated on weekdays. However, the mortality risks among patients who underwent TAAD surgery during nighttime and non-working hours were not significantly elevated compared to daytime and working hours admission.

Conclusions: Weekend surgery for TAAD was associated with a higher in-hospital mortality risk than weekday surgery. However, further studies are warranted to identify and develop strategies to improve the quality of round-the-clock care for patients with TAAD.

Keywords: Aortic dissection; Mortality; Postoperative complications.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Figure 1
Figure 1. PRISMA flow diagram.
PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; TAAD = type A aortic dissection.
Figure 2
Figure 2. Forest plot of the OR of in-hospital mortality associated with individual off-hour effects.
CI = confidence interval; OR = odds ratio.
Figure 3
Figure 3. Subgroup analysis of pooled ORs of in-hospital mortality between weekend- and weekday-treated patients.
CI = confidence interval; NA = not available; OR = odds ratio.
Figure 4
Figure 4. Sensitivity analysis of in-hospital mortality according to confounder component settings. pre-OP assessment only included the studies report adjusted results for pre-operation assessment, such as malperfusion syndrome, tamponade, cardiopulmonary arrest, or time from symptom onset to hospital arrival/surgery. Intra-OP procedure only included the studies report adjusted results for intra-operation procedure details, such as cardiopulmonary bypass time, aortic cross-clamp time, hypothermia circulatory arrest time, blood transfusion or replacement of total or hemi arch.
CI = confidence interval; OR = odds ratio; OP = operation.
See this image and copyright information in PMC

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