Is there a weekend effect in surgery for type A dissection? - Results from the NORCAAD database

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Aortic dissection type A requires immediate surgery. In general surgery populations, patients operated during weekends have higher mortality rates compared to patients operated on weekdays. The weekend effect in aortic dissection type A has not been studied in detail.

METHODS: The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) registry includes patients (N=1,159) who underwent type A dissection surgery at eight Nordic centers during 2005-2014. This study is based on data relating to surgery conducted during weekdays vs. weekends, and starting between 8 am and 8 pm ("daytime") vs. from 8 pm to 8 am ("nighttime"), as well as time from symptoms/admittance/diagnosis to surgery. The influence of timing of surgery on 30-day mortality was assessed using logistic regression analysis.

RESULTS: The 30-day mortality was 18% (204/1,159), with no difference in mortality between surgery performed on weekdays (17%, 150/889) and on weekends (20%, 54/270, p=0.45), or during nighttime (19%, 87/467) vs. daytime (17%, 117/680, p=0.54). Time from symptoms to surgery (median 7.0 hours vs. 6.5 hours, p=0.31) did not differ between patients who survived and those dead at 30 days. Multivariable regression analysis of risk factors for 30-day mortality showed no weekend effect (OR 1.04 [0.67-1.60], p=0.875), but nighttime surgery was a risk factor (OR 2.43 [1.29-4.56], p=0.006).

CONCLUSIONS: Thirty-day mortality in surgical repair of aortic dissection type A was not significantly affected by timing of surgery during weekends vs. weekdays. Nighttime surgery seems to predict increased 30-day mortality, after correction for other risk factors.

Details

Authors
  • Anders Ahlsson
  • Anders Wickbom
  • Arnar Geirsson
  • Anders Franco-Cereceda
  • Khalil Ahmad
  • Jarmo Gunn
  • Emma C Hansson
  • Vibeke Hjortdal
  • Kati Jarvela
  • Anders Jeppsson
  • Ari Mennander
  • Shahab Nozohoor
  • Emily Pan
  • Igor Zindovic
  • Tomas Gudbjartsson
  • Christian Olsson
Organisations
External organisations
  • Karolinska University Hospital
  • Karolinska Institutet
  • Örebro University Hospital
  • Aarhus University Hospital Skejby
  • Turku University Hospital
  • Sahlgrenska University Hospital
  • University of Gothenburg
  • Tampere University Hospital
  • Skåne University Hospital
  • University of Turku
  • National University Hospital of Iceland
  • University of Iceland
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems
Original languageEnglish
Pages (from-to)770-776
JournalAnnals of Thoracic Surgery
Volume108
Issue number3
Early online date2019 Apr 3
Publication statusPublished - 2019
Publication categoryResearch
Peer-reviewedYes