Outcome in Night- versus Daytime Surgery for Acute Type A Aortic Dissection

Background: Acute type A aortic dissection (TAAD) is a life-threatening condition which requires immediate surgical intervention at any time of day or night. We hypothesize that during nighttime, these procedures often are performed by surgeons less experienced in aortic surgery. Therefore, our aim was to investigate whether nighttime surgical procedures for TAAD are associated with adverse acute outcome.

Method: Data were retrospectively collected from the multicenter European registry of TAAD (ERTAAD) and 3.903 patients with surgery for TAAD between 2010 and 2021 were included for analysis. The overall cohort was stratified by day- or nighttime procedures (defined by initiation of surgery between 8 am to 8 pm and 8 pm to 8 am, respectively). Groups were compared using χ² test for categorical variables and the unpaired t-test for continuous variables. To adjust for differences in baseline characteristics, outcome comparisons were performed using multivariable logistic regression.

Results: During the study phase, 1,836 (47.0%) and 2,067 (53.0%) of patients underwent daytime and nighttime procedures, respectively. Both groups were equally treated by experienced aortic surgeons (≥20 aortic procedures/year; 81.1% vs. 82.6%; p-value 0.215).

Overall 30-day mortality was 17.9% (697 patients). In the adjusted regression analysis, there was no significant difference in 30-day mortality between groups (daytime: 18.4%, nighttime: 17.4%; OR: 0.875; 95% CI: 0.717–1.067; adjusted p-value 0.188). In the nighttime group, postprocedural acute kidney injury occurred significantly more often than in the daytime group (51.8 vs. 57.0%; OR: 0.794; 95% CI: 0.670–0.939; adjusted p-value = 0.007). No significant differences were found between the groups regarding neurological outcome, limb ischemia, sepsis, heart failure, or wound infections.

Conclusion: Nighttime surgical procedures for TAAD have been only associated with a higher rate of postoperative acute kidney injury. Other outcome measures as well as mortality have not been influenced by the time (daytime vs. nighttime) of the procedure.

Publication History

Article published online:
28 January 2023