Determinants of interhospital mortality in acute type A aortic dissection

Abstract

Objectives: To evaluate the impact of preoperative characteristics and interhospital distance on interhospital mortality in patients with acute type A aortic dissection.

Methods: Patients with acute type A aortic dissection referred to our institution for emergency surgery between May 2020 and December 2024 were retrospectively reviewed. Preoperative characteristics were obtained from registry data based on information available at the time of referral. Interhospital distance was measured in kilometers and min using a navigation application.

Results: Among 176 patients, 14 interhospital mortalities (8.0%) occurred after the transfer request, with a median interhospital distance of 47 min. Significant risk factors for interhospital mortality included pericardial effusion (odds ratio (OR): 4.03; 95% confidence interval (CI): 1.29-12.64), shock (OR: 97.84; 95% CI: 12.11-790.65), and cardiopulmonary resuscitation before referral (OR: 64.40; 95% CI: 6.57-631.20). Compared to patients referred from the hospitals located within 40 min, those referred from the hospitals within 40-80 min had a significantly higher risk of interhospital mortality (OR: 6.08; 95% CI: 1.39-42.2). In patients with shock, the cumulative incidence of cardiopulmonary resuscitation increased over time, reaching 21.9% at 60 min and 39.0% at 120 min after the referral request.

Conclusions: Pericardial effusion, shock, cardiopulmonary resuscitation before referral, and interhospital distance were identified as significant risk factors for interhospital mortality in patients with acute type A aortic dissection.

Keywords: Acute aortic dissection; interhospital distance; interhospital mortality; interhospital transfer.