P163. Impact of ″Pain-to-hospital admission time″ in Type A Acute Aortic Dissection Surgery on Postoperative Outcomes
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Affiliated Drum Tower Hospital of Nanjing University Medical School
China, Jiangsu
China - Contact Me
Dr. Xue Yunxing graduated from Nanjing Medical University and is currently the deputy chief physician of cardiovascular surgery at Nanjing Drum Tower Hospital in China. Dr. Xue is currently a member of Asian Society of Cardiovascular and Thoracic Surgery and academic secretary of Jiangsu Society of Cardiovascular Surgery (Jiangsu Province of China). Dr. Xue was also Visiting Scholar at the Cardiovascular Center of University of Texas Memorial Hermann Hospital and Cardiac Surgery of Massachusetts General Hospital. Dr. Xue had published over 30 papers included in SCI, the main research areas are aortic surgery and valve surgery.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
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.
Authors
Yunxing Xue (1), Vito Domenico Bruno (2), Fudong Fan (1), JUN PAN (1), Qing Zhou (1), Dongjin Wang (1)
Institutions
(1) Nanjing Drum Tower Hospital, Nanjing, China, (2) IRCCS Galeazzi – Sant’Ambrogio Hospital, Milan, Italy
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.
Authors
Yunxing Xue (1), Vito Domenico Bruno (2), Fudong Fan (1), JUN PAN (1), Qing Zhou (1), Dongjin Wang (1)
Institutions
(1) Nanjing Drum Tower Hospital, Nanjing, China, (2) IRCCS Galeazzi – Sant’Ambrogio Hospital, Milan, Italy
Presentation Duration
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