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Impact of after-hours surgery on outcomes of acute type A aortic dissection repair

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Abstract

Purpose

To establish whether emergency surgery performed outside working hours (after hours) contributed to adverse outcomes for patients with acute type A aortic dissection (ATAAD).

Methods

We reviewed the operation records of ATAAD repair in our institution from 2004 to 2019 (n = 187). Emergency surgery was performed by one of a few teams of experienced surgeons, regardless of the time of day. Patients were divided into two groups based on the surgery start time: during working hours (n = 65) and after hours (n = 122). A propensity score-matched analysis was performed for 58 pairs of patients.

Results

The overall in-hospital mortality was 6.9% for the working-hours group and 13.8% for the after-hours group. There were no significant differences between the groups in the relatively limited study population (n = 187). Surgeon experience and aortic interventions did not differ remarkably between the groups. After-hours repair was not associated with postoperative complications. There were no significant differences in the long-term survival or aortic event-free rates between the groups.

Conclusions

After-hours surgery did not affect the short- or long-term outcomes of ATAAD repair under our backup system, which supports the recommendation of immediate surgical repair. Efforts to minimize the discrepancies between working hours and after hours could help to improve the surgical outcomes of patients undergoing ATAAD repair.

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Acknowledgements

We thank the medical staff and surgeons who were involved in the surgeries evaluated in this study. We also thank Editage for their initial English language editing.

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Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-0937, Japan

    Baku Takahashi, Keiji Kamohara & Sojiro Amamoto

  2. Research and Education Center for Comprehensive Community Medicine, Faculty of Medicine, Saga University, Saga, Japan

    Atsushi Kawaguchi

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  1. Baku Takahashi
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  2. Keiji Kamohara
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  4. Atsushi Kawaguchi
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Correspondence to Baku Takahashi.

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Baku Takahashi and the other co-authors have no conflicts of interest to declare.

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Supplementary Information

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595_2022_2487_MOESM1_ESM.tif

Supplementary file1 Fig. S1. Mirrored histogram of the distribution of propensity scores for patients who underwent surgery during working hours (red bars) vs. those who underwent surgery after hours (blue bars). A: Before matching; B: After matching. (TIF 3567 KB)

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Takahashi, B., Kamohara, K., Amamoto, S. et al. Impact of after-hours surgery on outcomes of acute type A aortic dissection repair. Surg Today 52, 1453–1462 (2022). https://doi.org/10.1007/s00595-022-02487-7

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  • DOI: https://doi.org/10.1007/s00595-022-02487-7

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