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.

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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

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