Time of day does not influence outcomes in acute type A aortic dissection: Results from the IRAD

G. Arnaoutakis
V. Bianco
A. L. Estrera
D. R. Brinster, Zucker School of Medicine at Hofstra/Northwell
M. P. Ehrlich
M. D. Peterson
E. Bossone
T. Myrmel
D. Pacini
D. G. Montgomery
K. A. Eagle
R. Bekeredijan
S. Shalhub
C. De Vincentiis
G. Chad Hughes
E. P. Chen
H. H. Eckstein
C. A. Nienaber
I. Sultan

Abstract

© 2020 Wiley Periodicals LLC Background: Type A acute aortic dissection (TAAAD) represents a surgical emergency requiring intervention regardless of time of day. Whether such a “evening effect” exists regarding outcomes for TAAAD has not been previously studied using a large registry data. Methods: Patients with TAAAD were identified from the International Registry of Acute Aortic Dissections (1996–2019). Outcomes were compared between patients undergoing operative repair during the daytime (D), defined as 8 am–5 pm, versus the evening (N), defined as 5 pm–8 am. Results: Four thousand one-hundrd and ninety-seven surgically treated patients with TAAAD were identified, with 1824 patients undergoing daytime surgery (43.5%) and 2373 patients undergoing evening surgery (56.5%). Daytime patients were more likely to have undergone prior cardiac surgery (13.2% vs. 9.5%; p <.001) and have had a prior aortic dissection (4.8% vs. 3.4%; p =.04). Evening patients were more likely to have been transferred from a referring hospital (70.8% vs. 75.0%; p =.003). Daytime patients were more likely to undergo aortic valve sparing root procedures (23.3% vs. 19.2%; p =.035); however, total arch replacement was performed with equal frequency (19.4% vs. 18.8%; p =.751). In-hospital mortality (D: 17.3% vs. N. 16.2%; p =.325) was similar between both groups. Subgroup analysis examining the effect of weekend presentation revealed no significant mortality difference. Conclusions: A majority of TAAAD patients underwent surgical repair at night. There were higher rates of postoperative tamponade in evening patients; however, mortality was similar. The expertise of cardiac-dedicated operative and critical care teams regardless of time of day as well as training paradigms may explain similar mortality outcomes in this high risk population.