The Influence of Geography and Referral Timing on Hospital Outcome Following Emergency Surgery for Type A Aortic Dissection: Insights from a National Cohort

P0341 

Abstract Submission 

George Gradinariu (1), Hussein El-Shafei (2), Renzo Pessotto (3), Mark Danton (4)

(1) Golden Jubilee National Hospital, United Kingdom, (2) Aberdeen Royal Infirmary, Aberdeen, NA, (3) N/A, Edinburgh, (4) N/A, Glasgow, United Kingdom

George Gradinariu    -  Contact Me
Golden Jubilee National Hospital

Hussein El-Shafei    -  Contact Me
Aberdeen Royal Infirmary

Renzo Pessotto    -  Contact Me
N/A

Mark Danton    -  Contact Me
N/A

George Gradinariu    -  Contact Me
Golden Jubilee National Hospital

Objective: Type A aortic dissection (TAAD) is considered a time-critical condition. The time needed for diagnosis and transfer to surgery may affect survival. We analyzed the impact of geography and time from TAAD diagnosis to surgery on hospital mortality using a national registry.
Methods: All patients undergoing emergency TAAD repair in 3 centres between 2008 and 2022 were included. The primary endpoint was all-cause in-hospital mortality. Times from diagnostic scan to surgery (T1) and first imaging to surgery (T2) were recorded. We defined early (2008-2014) vs. recent (2015-2022) eras.
Results: 357 patients referred from 35 emergency departments across 12 distinct geographic health regions were included. 70% [249/357] were male. Males were younger than females [58±14 vs.64±14 years, p<0.001]. Median diagnosis-to-surgery (T1) and overall time (T2) were 5 hrs [IQR:3.7-6.7] and 7.4 hrs [IQR 5-21.5] respectively. Median T1 [4.5 vs. 5.8 hrs, p<0.001] and T2 [6.6 vs. 10.2 hrs, p<0.001] were significantly shorter in the recent era. Patients from health regions without a surgical centre [n=161, 47%] had significantly longer median T1 [5.5 vs.4.4 hrs, p<0.001] compared to patients in health regions with a surgical centre [n=185, 54%].
Hospital mortality was 26% [93/357], decreasing from 30% [33/109] to 24% [60/248], p=0.24 in the recent period. Comparing survivors with non-survivors, there were no differences in times to surgery: T1 [5 vs. 4.9 hrs, p=0.68] and T2 [7.4 vs. 7.1 hrs, p=0.72]. Mortality was similar 24.7% [47/143] vs. 27.5% [46/121], p=0.55 for patients referred from within vs. outside a surgical health region. Distances from home to a referring centre (7 [IQR 4-16] vs. 8 miles [IQR 4-18], p=0.2) or surgical centre (32 [IQR 14-58] vs. 36 miles [IQR 16-69], p=0.46) were similar for survivors and non-survivors. Age was associated with mortality, OR 1.05 [95%CI 1.03-1.07, p<0.001], while gender [OR 0.94 [95%CI 0.57-1.57, p=0.89] was not. 39% [139/357] of patients had pericardial effusion on diagnostic CT scan. This was associated with higher mortality [OR 1.80; 95%CI 1.11-2.90, p=0.02].
Conclusion: Over a 14 year-period, time from TAAD diagnosis to surgery decreased. Patients in regions with surgical centres had faster access to treatment. Hospital mortality was associated with patient and disease-specific factors, such as age and pericardial effusion at presentation, while geographical factors and time to surgery had no impact on the outcome.

Aortic Surgery Forum (Basic Aortic Research, Venue for Residents, Fellows, Junior Attendings)