Is there a weekend effect in surgery for type A dissection? - Results from the NORCAAD database
(2019) In Annals of Thoracic Surgery 108(3). p.770-776- Abstract
BACKGROUND: Aortic dissection type A requires immediate surgery. In general surgery populations, patients operated during weekends have higher mortality rates compared to patients operated on weekdays. The weekend effect in aortic dissection type A has not been studied in detail.
METHODS: The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) registry includes patients (N=1,159) who underwent type A dissection surgery at eight Nordic centers during 2005-2014. This study is based on data relating to surgery conducted during weekdays vs. weekends, and starting between 8 am and 8 pm ("daytime") vs. from 8 pm to 8 am ("nighttime"), as well as time from symptoms/admittance/diagnosis to surgery. The influence of timing of... (More)
BACKGROUND: Aortic dissection type A requires immediate surgery. In general surgery populations, patients operated during weekends have higher mortality rates compared to patients operated on weekdays. The weekend effect in aortic dissection type A has not been studied in detail.
METHODS: The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) registry includes patients (N=1,159) who underwent type A dissection surgery at eight Nordic centers during 2005-2014. This study is based on data relating to surgery conducted during weekdays vs. weekends, and starting between 8 am and 8 pm ("daytime") vs. from 8 pm to 8 am ("nighttime"), as well as time from symptoms/admittance/diagnosis to surgery. The influence of timing of surgery on 30-day mortality was assessed using logistic regression analysis.
RESULTS: The 30-day mortality was 18% (204/1,159), with no difference in mortality between surgery performed on weekdays (17%, 150/889) and on weekends (20%, 54/270, p=0.45), or during nighttime (19%, 87/467) vs. daytime (17%, 117/680, p=0.54). Time from symptoms to surgery (median 7.0 hours vs. 6.5 hours, p=0.31) did not differ between patients who survived and those dead at 30 days. Multivariable regression analysis of risk factors for 30-day mortality showed no weekend effect (OR 1.04 [0.67-1.60], p=0.875), but nighttime surgery was a risk factor (OR 2.43 [1.29-4.56], p=0.006).
CONCLUSIONS: Thirty-day mortality in surgical repair of aortic dissection type A was not significantly affected by timing of surgery during weekends vs. weekdays. Nighttime surgery seems to predict increased 30-day mortality, after correction for other risk factors.
(Less)
- author
- organization
- publishing date
- 2019-04-03
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Annals of Thoracic Surgery
- volume
- 108
- issue
- 3
- pages
- 770 - 776
- publisher
- Elsevier
- external identifiers
-
- pmid:30953648
- scopus:85069719973
- ISSN
- 1552-6259
- DOI
- 10.1016/j.athoracsur.2019.03.005
- language
- English
- LU publication?
- yes
- additional info
- Copyright © 2019. Published by Elsevier Inc.
- id
- 3afe9eb2-2f8a-4360-a52f-35b09c748ff3
- date added to LUP
- 2019-05-22 09:10:20
- date last changed
- 2024-04-16 07:42:06
@article{3afe9eb2-2f8a-4360-a52f-35b09c748ff3,
abstract = {{<p>BACKGROUND: Aortic dissection type A requires immediate surgery. In general surgery populations, patients operated during weekends have higher mortality rates compared to patients operated on weekdays. The weekend effect in aortic dissection type A has not been studied in detail.</p><p>METHODS: The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) registry includes patients (N=1,159) who underwent type A dissection surgery at eight Nordic centers during 2005-2014. This study is based on data relating to surgery conducted during weekdays vs. weekends, and starting between 8 am and 8 pm ("daytime") vs. from 8 pm to 8 am ("nighttime"), as well as time from symptoms/admittance/diagnosis to surgery. The influence of timing of surgery on 30-day mortality was assessed using logistic regression analysis.</p><p>RESULTS: The 30-day mortality was 18% (204/1,159), with no difference in mortality between surgery performed on weekdays (17%, 150/889) and on weekends (20%, 54/270, p=0.45), or during nighttime (19%, 87/467) vs. daytime (17%, 117/680, p=0.54). Time from symptoms to surgery (median 7.0 hours vs. 6.5 hours, p=0.31) did not differ between patients who survived and those dead at 30 days. Multivariable regression analysis of risk factors for 30-day mortality showed no weekend effect (OR 1.04 [0.67-1.60], p=0.875), but nighttime surgery was a risk factor (OR 2.43 [1.29-4.56], p=0.006).</p><p>CONCLUSIONS: Thirty-day mortality in surgical repair of aortic dissection type A was not significantly affected by timing of surgery during weekends vs. weekdays. Nighttime surgery seems to predict increased 30-day mortality, after correction for other risk factors.</p>}},
author = {{Ahlsson, Anders and Wickbom, Anders and Geirsson, Arnar and Franco-Cereceda, Anders and Ahmad, Khalil and Gunn, Jarmo and Hansson, Emma C and Hjortdal, Vibeke and Jarvela, Kati and Jeppsson, Anders and Mennander, Ari and Nozohoor, Shahab and Pan, Emily and Zindovic, Igor and Gudbjartsson, Tomas and Olsson, Christian}},
issn = {{1552-6259}},
language = {{eng}},
month = {{04}},
number = {{3}},
pages = {{770--776}},
publisher = {{Elsevier}},
series = {{Annals of Thoracic Surgery}},
title = {{Is there a weekend effect in surgery for type A dissection? - Results from the NORCAAD database}},
url = {{http://dx.doi.org/10.1016/j.athoracsur.2019.03.005}},
doi = {{10.1016/j.athoracsur.2019.03.005}},
volume = {{108}},
year = {{2019}},
}