10-Year Trends in Aortic Dissection: Mortality and Weekend Effect within the US Nationwide Emergency Department Sample (NEDS)

Authors

  • James A. Brown, MA Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
  • Bushra Usmani, MD Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
  • George J. Arnaoutakis, MD Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, FL, USA
  • Derek Serna-Gallegos, MD Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
  • Konstadinos A. Plestis, MD Jefferson Aortic Center, Abington – Jefferson Health, Abington, PA, USA
  • Syed Mahmood Shah, MD Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
  • Forozan Navid, MD Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
  • Courtenay Dunn-Lewis, PhD Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
  • Michael J. Singh, MD Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
  • Ibrahim Sultan, MD Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA

DOI:

https://doi.org/10.1532/hsf.3681

Keywords:

aortic dissection, aortic aneurysm, aortic surgery, emergency department, mortality

Abstract

Background: This study examined changes in aortic dissection (AD) mortality from 2006 to 2017 and assessed the impact of weekday versus weekend presentation upon mortality.

Methods: This observational study analyzed all records in the Nationwide Emergency Department Sample (NEDS) database. NEDS aggregates discharge data from 984 hospitals in 36 states and the District of Columbia in the United States of America. All patients with thoracic and thoracoabdominal AD recorded as their principal diagnosis were identified via ICD codes.

Results: Patient characteristics (weekday|weekend) count: 26,759|9,640, P = 0.016; age (years): 65.2 ± 15.8|64.7 ± 16.2, P = 0.016; women: 11,318 (42.3%)|4,086 (42.4), P = 0.883; Charlson comorbidity index: 2.3 ± 1.7|2.3 ± 1.6, P = 0.025. There were 36,399 ED visits with diagnosed AD. Annual AD diagnoses increased by 70% from 2006 to 2017. From 2012-2017, patients had lower in-hospital mortality (9.9% versus 11.9%, P < 0.001) compared with 2006-2011. Patients reporting during the weekend had higher in-hospital mortality (11.8% versus 10.4%, P < 0.001) compared with weekdays. On multivariable analysis, year of presentation remained independently associated with in-hospital mortality, with 2012-2017 being associated with reduced mortality (odds ratio (OR) 0.90, 95% CI: 0.82, 0.99, P = 0.031), as compared with 2006-2011. Weekend presentation remained independently associated with worse in-hospital mortality (OR 1.17, 95% CI: 1.05, 1.29, P = 0.003) compared with weekday presentation.

Conclusion: Although AD mortality is decreasing, the patients presenting on the weekend were 13% more likely to die in the hospital compared with patients presenting during the week.

References

Abe T, Yamamoto H, Miyata H, et al. 2020. Patient trends and outcomes of surgery for type A acute aortic dissection in Japan: an analysis of more than 10 000 patients from the Japan Cardiovascular Surgery Database. Eur J Cardiothorac Surg. 57(4):660-667.

Ahlsson A, Wickbom A, Geirsson A, et al. 2019. Is There a Weekend Effect in Surgery for Type A Dissection?: Results From the Nordic Consortium for Acute Type A Aortic Dissection Database. Ann Thorac Surg. 108(3):770-776.

Andersen ND, Benrashid E, Ross AK, et al. 2016. The utility of the aortic dissection team: outcomes and insights after a decade of experience. Ann Cardiothorac Surg. 5(3):194-201.

Arnaoutakis G, Bianco V, Estrera AL, et al. 2020. Time of day does not influence outcomes in acute type A aortic dissection: Results from the IRAD. J Card Surg.

Brown JA, Arnaoutakis GJ, Kilic A, Gleason TG, Aranda-Michel E, Sultan I. 2020. Current trends in the management of acute type A aortic intramural hematoma. J Card Surg. 35(9):2331-2337.

Brown JA, Arnaoutakis GJ, Kilic A, Gleason TG, Aranda-Michel E, Sultan I. 2020. Medical and surgical management of acute type B aortic intramural hematoma. J Card Surg. 35(9):2324-2330.

Chiappini B, Schepens M, Tan E, et al. 2005. Early and late outcomes of acute type A aortic dissection: analysis of risk factors in 487 consecutive patients. Eur Heart J. 26(2):180-186.

Chikwe J, Cavallaro P, Itagaki S, Seigerman M, Diluozzo G, Adams DH. 2013. National outcomes in acute aortic dissection: influence of surgeon and institutional volume on operative mortality. Ann Thorac Surg. 95(5):1563-1569.

David TE, Armstrong S, Ivanov J, Barnard S. 1999. Surgery for acute type A aortic dissection. Ann Thorac Surg. 67(6):1999-2001; discussion 2014-1999.

DeMartino RR, Sen I, Huang Y, et al. 2018. Population-Based Assessment of the Incidence of Aortic Dissection, Intramural Hematoma, and Penetrating Ulcer, and Its Associated Mortality From 1995 to 2015. Circ Cardiovasc Qual Outcomes. 11(8):e004689.

Dufendach KA, Sultan I, Gleason TG. 2019. Distal Extent of Surgery for Acute Type A Aortic Dissection. Operative Techniques in Thoracic and Cardiovascular Surgery. 24(2):82-102.

El Asmar A, Dakessian A, Bachir R, El Sayed M. 2019. Out of hospital cardiac arrest outcomes: Impact of weekdays vs weekends admission on survival to hospital discharge. Resuscitation. 143:29-34.

Evangelista A, Isselbacher EM, Bossone E, et al. 2018. Insights From the International Registry of Acute Aortic Dissection: A 20-Year Experience of Collaborative Clinical Research. Circulation. 137(17):1846-1860.

Fattori R, Tsai TT, Myrmel T, et al. 2008. Complicated acute type B dissection: is surgery still the best option?: a report from the International Registry of Acute Aortic Dissection. JACC Cardiovasc Interv. 1(4):395-402.

Groves EM, Khoshchehreh M, Le C, Malik S. 2014. Effects of weekend admission on the outcomes and management of ruptured aortic aneurysms. J Vasc Surg. 60(2):318-324.

Hirst AE, Jr., Johns VJ, Jr., Kime SW, Jr. 1958. Dissecting aneurysm of the aorta: a review of 505 cases. Medicine (Baltimore). 37(3):217-279.

Lai DT, Robbins RC, Mitchell RS, et al. 2002. Does profound hypothermic circulatory arrest improve survival in patients with acute type a aortic dissection? Circulation. 106 (12 Suppl 1):I218-228.

Lawton JS, Liu J, Kulshrestha K, et al. 2015. The impact of surgical strategy on survival after repair of type A aortic dissection. J Thorac Cardiovasc Surg. 150(2):294-301 e291.

Mehta RH, Manfredini R, Bossone E, et al. 2005. Does circadian and seasonal variation in occurrence of acute aortic dissection influence in-hospital outcomes? Chronobiol Int. 22(2):343-351.

Mehta RH, Suzuki T, Hagan PG, et al. 2002. Predicting death in patients with acute type a aortic dissection. Circulation. 105(2):200-206.

Moon MR, Sundt TM, 3rd, Pasque MK, et al. 2001. Does the extent of proximal or distal resection influence outcome for type A dissections? Ann Thorac Surg. 71(4):1244-1249; discussion 1249-1250.

Pape LA, Awais M, Woznicki EM, et al. 2015. Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection: 17-Year Trends From the International Registry of Acute Aortic Dissection. J Am Coll Cardiol. 66(4):350-358.

Qiu J, Zhang L, Luo X, et al. 2018. Higher Mortality in Patients Undergoing Nighttime Surgical Procedures for Acute Type A Aortic Dissection. Ann Thorac Surg. 106(4):1164-1170.

Ramirez DA, Porco TC, Lietman TM, Keenan JD. 2018. Ocular Injury in United States Emergency Departments: Seasonality and Annual Trends Estimated from a Nationally Representative Dataset. Am J Ophthalmol. 191:149-155.

Sultan I, Bavaria JE, Szeto W. 2016. Hybrid Techniques for Aortic Arch Aneurysm Repair. Semin Cardiothorac Vasc Anesth. 20(4):327-332.

Sultan I, Bianco V, Yazji I, et al. 2018. Hemiarch Reconstruction Versus Clamped Aortic Anastomosis for Concomitant Ascending Aortic Aneurysm. Ann Thorac Surg. 106(3):750-756.

Sultan I, McGarvey J, Vallabhajosyula P, Desai ND, Bavaria JE, Szeto WY. 2016. Routine use of hemiarch during acute type A aortic dissection repair. Ann Cardiothorac Surg. 5(3):245-247.

Sultan I, Wallen TJ, Habertheuer A, et al. 2017. Concomitant antegrade stent grafting of the descending thoracic aorta during transverse hemiarch reconstruction for acute DeBakey I aortic dissection repair improves aortic remodeling. J Card Surg. 32(9):581-592.

Tolenaar JL, Froehlich W, Jonker FH, et al. 2014. Predicting in-hospital mortality in acute type B aortic dissection: evidence from International Registry of Acute Aortic Dissection. Circulation. 130(11 Suppl 1):S45-50.

Trimarchi S, Nienaber CA, Rampoldi V, et al. 2006. Role and results of surgery in acute type B aortic dissection: insights from the International Registry of Acute Aortic Dissection (IRAD). Circulation. 114(1 Suppl):I357-364.

Trivedi D, Navid F, Balzer JR, et al. 2016. Aggressive Aortic Arch and Carotid Replacement Strategy for Type A Aortic Dissection Improves Neurologic Outcomes. Ann Thorac Surg. 101(3):896-903; Discussion 903-895.

Vallabhajosyula P, Gottret JP, Menon R, et al. 2017. Central Repair With Antegrade TEVAR for Malperfusion Syndromes in Acute Debakey I Aortic Dissection. Ann Thorac Surg. 103(3):748-755.

White AM, Slater ME, Ng G, Hingson R, Breslow R. 2018. Trends in Alcohol-Related Emergency Department Visits in the United States: Results from the Nationwide Emergency Department Sample, 2006 to 2014. Alcohol Clin Exp Res. 42(2):352-359.

Zierer A, Moon MR, Melby SJ, et al. 2007. Impact of perfusion strategy on neurologic recovery in acute type A aortic dissection. Ann Thorac Surg. 83(6):2122-2128; discussion 2128-2129.

Zimmerman KP, Oderich G, Pochettino A, et al. 2016. Improving mortality trends for hospitalization of aortic dissection in the National Inpatient Sample. J Vasc Surg. 64(3):606-615 e601.

Published

2021-03-31

How to Cite

Brown, J., Usmani, B., Arnaoutakis, G., Serna-Gallegos, D., Plestis, K., Shah, S., Navid, F., Lewis, C., Singh, M., & Sultan, I. (2021). 10-Year Trends in Aortic Dissection: Mortality and Weekend Effect within the US Nationwide Emergency Department Sample (NEDS). The Heart Surgery Forum, 24(2), E336-E344. https://doi.org/10.1532/hsf.3681

Issue

Vol. 24 No. 2 (2021)

Section

Article
Author Disclosure & Copyright Transfer Agreement