P044. Aortic Dissections in the Elderly: Older Age is Associated with Increased Time to Surgery in Patients with Acute Aortic Syndromes
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Rutgers Robert Wood Johnson Medical School
New Brunswick, NJ
United States - Contact Me
As a child growing up in Brooklyn, New York, one of my dreams was to become a doctor. When I learned more about the field of medicine I chose surgery as my area of interest with cardiac surgery as my main focus. After completing my residency at Duke University, my main goal was to be a successful academic surgeon. I’m currently in my 10th year at Rutgers Robert Wood Johnson Hospital in New Brunswick, New Jersey. One of my main goals as an Attending was to demonstrate and achieve academic and clinical excellence as a faculty member. I'm continuing my journey to achieve these goals.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective:
In the setting of Acute Aortic Syndromes, timely access to definitive surgical repair is of paramount importance. Older patients, primarily septuagenarians and octogenarians, undergoing emergent Ascending Arch Repair experience higher rates of mortality compared to younger patients. Despite this risk, studies show that surgical management is still superior to medical management for this patient population. The objective of this study is to determine if older age impacts the time from presentation to start of surgery for patients with Acute Aortic Syndromes undergoing surgical repair.
Methods: This retrospective review included all patients with Acute Aortic Syndromes who underwent emergent Ascending Aortic Arch Repair from January 2018 to May 2023 at a single academic institution. Our analysis compared outcomes for older patients (age 70 years and older) with younger patients (age less than 70 years). Primary outcomes included time from Emergency Department presentation to the start of surgery and time from diagnosis with Computerized Tomography to start of surgery. Secondary outcomes included intraoperative and 30-Day mortality, postoperative stay, and complications. Outcomes were analyzed using Chi-squared, Fisher's Exact, and t-tests, with significance set at p<0.05.
Results:
Of 107 patients included, 71 (66%) were under the age of 70 and 36 (34%) were 70 years of age or older. The younger cohort had more male and non-White patients, with no differences in rates of hypertension, dyslipidemia, and smoking history. With no difference in the rate of transfers from outside hospitals, we observed longer times from presentation to start of surgery for older patients compared to younger patients (7 hours and 13 minutes vs. 6 hours 25 minutes; p=0.02), and also for time of diagnosis to start of surgery (4 hours 22 minutes vs. 3 hours 54 minutes (p= 0.006). Older patients had higher rates of intraoperative (0% vs. 17%, p<0.001) and 30-day (7% vs. 44 %, p<0.001) mortality. There were no differences in length of stay, or in rates of postoperative complications and surgery-related Emergency Department visits.
Conclusions:
Patients aged 70 and older experienced delays from time of presentation to start of surgery and from time of diagnosis to start of surgery. Age should not delay an individual from receiving timely transfer to a tertiary center for higher level of care to better assess the patient's operative candidacy and determine appropriate treatment.
Authors
Anthony Lemaire (1), Sorasicha Nithikasem (1), Abhishek Chakraborty (2), George Hung (1), Hirohisa Ikegami (1), Manabu Takebe (1), Mark Russo (3), Leonard Lee (4)
Institutions
(1) Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, (2) Rutgers Robert Wood Johnson Medical School, New Brunswick,NJ, (3) Robert Wood Johnson University Hospital, Green Village, NJ, (4) Robert Wood Johnson University Hospital, New Brunswick, NJ
In the setting of Acute Aortic Syndromes, timely access to definitive surgical repair is of paramount importance. Older patients, primarily septuagenarians and octogenarians, undergoing emergent Ascending Arch Repair experience higher rates of mortality compared to younger patients. Despite this risk, studies show that surgical management is still superior to medical management for this patient population. The objective of this study is to determine if older age impacts the time from presentation to start of surgery for patients with Acute Aortic Syndromes undergoing surgical repair.
Methods: This retrospective review included all patients with Acute Aortic Syndromes who underwent emergent Ascending Aortic Arch Repair from January 2018 to May 2023 at a single academic institution. Our analysis compared outcomes for older patients (age 70 years and older) with younger patients (age less than 70 years). Primary outcomes included time from Emergency Department presentation to the start of surgery and time from diagnosis with Computerized Tomography to start of surgery. Secondary outcomes included intraoperative and 30-Day mortality, postoperative stay, and complications. Outcomes were analyzed using Chi-squared, Fisher's Exact, and t-tests, with significance set at p<0.05.
Results:
Of 107 patients included, 71 (66%) were under the age of 70 and 36 (34%) were 70 years of age or older. The younger cohort had more male and non-White patients, with no differences in rates of hypertension, dyslipidemia, and smoking history. With no difference in the rate of transfers from outside hospitals, we observed longer times from presentation to start of surgery for older patients compared to younger patients (7 hours and 13 minutes vs. 6 hours 25 minutes; p=0.02), and also for time of diagnosis to start of surgery (4 hours 22 minutes vs. 3 hours 54 minutes (p= 0.006). Older patients had higher rates of intraoperative (0% vs. 17%, p<0.001) and 30-day (7% vs. 44 %, p<0.001) mortality. There were no differences in length of stay, or in rates of postoperative complications and surgery-related Emergency Department visits.
Conclusions:
Patients aged 70 and older experienced delays from time of presentation to start of surgery and from time of diagnosis to start of surgery. Age should not delay an individual from receiving timely transfer to a tertiary center for higher level of care to better assess the patient's operative candidacy and determine appropriate treatment.
Authors
Anthony Lemaire (1), Sorasicha Nithikasem (1), Abhishek Chakraborty (2), George Hung (1), Hirohisa Ikegami (1), Manabu Takebe (1), Mark Russo (3), Leonard Lee (4)
Institutions
(1) Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, (2) Rutgers Robert Wood Johnson Medical School, New Brunswick,NJ, (3) Robert Wood Johnson University Hospital, Green Village, NJ, (4) Robert Wood Johnson University Hospital, New Brunswick, NJ
Presentation Duration
PODS will be on display in the exhibit hall for the duration of the meeting during exhibit hall hours. PODS will also be available for viewing on the meeting website. There is no formal presentation associated with your POD, but we encourage you to visit the PODS area during breaks to connect with those viewing.