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Is there a weekend effect in surgery for type A dissection? - Results from the NORCAAD database

Ahlsson, Anders; Wickbom, Anders; Geirsson, Arnar; Franco-Cereceda, Anders; Ahmad, Khalil; Gunn, Jarmo; Hansson, Emma C; Hjortdal, Vibeke; Jarvela, Kati and Jeppsson, Anders, et al. (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.

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Annals of Thoracic Surgery
volume
108
issue
3
pages
770 - 776
publisher
Elsevier
external identifiers
  • scopus:85069719973
ISSN
1552-6259
DOI
10.1016/j.athoracsur.2019.03.005
language
English
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yes
id
3afe9eb2-2f8a-4360-a52f-35b09c748ff3
date added to LUP
2019-05-22 09:10:20
date last changed
2019-10-23 06:15:52
@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},
  volume       = {108},
  year         = {2019},
}