P154. Impact of Geographic Proximity on Survival in Stanford Type A Aortic Dissection Patients Undergoing Surgical Repair: A Single-Center Observational Study
Minneapolis, MN
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Dr. Huddleston joined the faculty at the University of Minnesota in December 2015 where he is an Associate Professor of Surgery in the Division of Cardiothoracic Surgery, and the Surgical Director of the Lung Transplant Program at the University of Minnesota Medical Center. As such, his primary academic interest is in lung transplantation with a focus on clinical outcomes and transplant immunology, as well as ex vivo lung perfusion. He has been the site principal investigator for two multicenter clinical trials examining the role of warm ex vivo lung perfusion in lung transplant. The device used for this research, TransMedics Lung OCS, is now FDA approved and expanding the donor pool. Also, he collaborates with world-renowned immunologist Marc Jenkins, PhD using advanced immunologic techniques to detect and characterize CD4+ T cells with specificity for the donor lung in the blood of lung transplant recipients. He is also the Director of the Aortic Center with a strong interest in aortic dissection, repair of thoracic and thoracoabdominal aortic aneurysms, and surgical outcomes after aortic surgery. In addition, he is the Chief of Cardiac Surgery at St. Johns Hospital in Maplewood, MN.
Dr. Huddleston received his medical degree from Columbia University in 2000 and completed his internship and residency in General Surgery at the University of Minnesota. Dr. Huddleston received his Ph.D. in surgery at University of Minnesota in 2009 defending his thesis, “Graft Antigen-Specific CD4+ T cells require CD154 Expression to Clonally Expand and Differentiate to the Th1 phenotype and initiate mTOR Dependent Intimal Hyperplasia in Cardiac Allografts.” After completing his cardiothoracic surgery training at the Johns Hopkins Hospital in Baltimore, MD, he was a private practice cardiothoracic surgeon at St. Luke’s Hospital in Duluth, MN starting in 2012 until he returned to the University of Minnesota. He is board certified in Surgery and Thoracic Surgery.
Description
Methods: Patients with TAAD who underwent surgical repair between 2011 and the second quarter of 2023 were identified in this single-center observational study. Patients were categorized into groups based on the distance from their residential zip code to the university hospital. Survival analysis employed the Kaplan-Meier method, and the influence of distance was assessed using the Cox proportional hazard model. Log rank test was done for multiple comparison to evaluate survival difference between the groups.
Results: 240 patients with TAAD who underwent surgical repair were identified. Median age was 61.1 (IQR 51.2-72.2), with 32.4% female. Median distance from patient's residential zip code to the university hospital is 25.4 miles (IQR 10.4-121.6 miles). Discharge mortality was 5.3%, 4.3%, 4.2%, 5.8% for patients who reside within 25 miles, 25-50 miles, 50-100 miles, and more than 100 miles from the hospital (p = 0.99). Log rank multiple comparison test revealed no difference between the four groups with all p-value greater than 0.50. Similarly, 30-day mortality for patients who reside within 25 miles, 25-50 miles, 50-100 miles, and more than 100 miles from the hospital was 7.3%, 12.5%, 3.8%, 6.3% respectively (p = 0.68). No difference was found from the log rank multiple comparison test (p> 0.46).
Conclusions: This study found no significant association between geographical proximity to the medical facility providing surgical repair and patient survival outcomes in cases of TAAD undergoing surgical repair. These results suggest that although access to timely medical care is important, it is not a limiting factor in achieving favorable clinical outcomes in this single-center setting.
Authors
Qianyun Luo (1), Stephen Huddleston (1), Qianyun Luo (1), Renxi Li (2), Ranjit John (1), Sara Shumway (3), Matthew Soule (1), K. Joshua Wong (1), Rochus Voeller (4), Andrew Shaffer (1), Rosemary Kelly (1)
Institutions
(1) University of Minnesota Medical Center, Minneapolis, MN, (2) N/A, N/A, (3) Univ of Minnesota Medical Center, Minneapolis, MN, (4) University of Minnesota Medical Center, United States