Impact of ″pain-to-hospital admission time″ in type A acute aortic dissection surgery on postoperative outcomes

P0163 

Abstract Submission 

Yunxing Xue (1), Vito Domenico Bruno (2), Fudong Fan (1), JUN PAN (1), Qing Zhou (1), Dongjin Wang (1)

(1) Nanjing Drum Tower Hospital, Nanjing, China, (2) IRCCS Galeazzi – Sant’Ambrogio Hospital, Milan, Italy

Yunxing Xue    -  Contact Me
Nanjing Drum Tower Hospital

Vito Domenico Bruno    -  Contact Me
IRCCS Galeazzi – Sant’Ambrogio Hospital

Fudong Fan    -  Contact Me
Nanjing Drum Tower Hospital

JUN PAN    -  Contact Me
Nanjing Drum Tower Hospital

Qing Zhou    -  Contact Me
Nanjing Drum Tower Hospital

Dongjin Wang    -  Contact Me
Nanjing Drum Tower Hospital

Yunxing Xue    -  Contact Me
N/A

Introduction: Type A Aortic Dissection (TAAD) is a life-threatening disease that requires emergency surgical treatment. With a mortality rate reported as high as 1-2% per hour, the time to admission to hospital represent a crucial point in the management of these patients. We aimed to investigate the impact of time to admission on postoperative outcomes after TAAD repair.
Methods: From January 2011 to January 2020, 1406 consecutive patients underwent TAAD repair at our centre. After removing patients with no data on the timing of admission and patients admitted more than 72 hours from the onset of pain, the final dataset included 1228 patients which were divided in two groups: 867 patients were in the early( ≤12 hours) and 361 were in the late (> 12 hours) admission group.
Results: The median age was 53 years (IQR: 44 - 63) and 25% of the patients were female. Hypotension (11% vs 1.9%, p < 0.01) and bradycardia on admission (11% vs 1.9%, p < 0.01) were more common in the early group. This group also had an higher incidence of preoperative limb ischemia (17% vs 11%, p <0.01) and higher rates of rescue surgeries (16% vs 11%, p = 0.05). Despite prompt intervention, the postoperative mortality rate was higher in the early group (15% vs 9.4%, p = 0.01). Postoperative stroke rates were also higher in the early group (5.8% vs 2.8%, p = 0.03). The early group also had a significant higher incidence of postoperative kidney failure (29% vs 21%, p < 0.01) When adjusted for age and gender, the early group was an independent predictor of mortality (p < 0.01 vs late).
Conclusion: Our analysis confirms the results of previous studies showing that TAAD patients with a quicker admission present with more severe symptoms and ischemic signs and, despite early treatment, they have increased rates of complications and mortality emphasizing the importance of the clinical status on admission, rather than the time, as the main driver for postoperative complications.

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