Acute type A aortic dissection repair 'after-hours': does it influence outcomes?

Abstract Background Time of day has been associated with adverse outcomes in certain surgical pathologies. Given that acute type A aortic dissection typically mandates immediate repair, relatively little attention has been paid to any potential impact of the day/night timing of the operation itself. We sought to determine whether those patients with acute dissection treated during typical ‘working-hours' demonstrated any difference in outcomes vs. those who required surgery ‘after-hours.' Methods A comprehensive review was undertaken of our prospectively collected database from July 2014 to October 2018; 164 consecutive patients underwent primary repair of an acute type A dissection. Based upon the procedure start time, patients were divided into 2 groups: ‘working-hours' (7am - 4pm, Monday to Friday, n=60), and ‘after-hours' (all other times, including weekends and holidays, n=104). We propensity-matched 58 pairs of patients and analyzed perioperative data and short-term clinical outcomes. Results Thirty-day mortality for all 164 patients was 10.4% (17 deaths), not significantly different between the two matched groups (‘working-hours,' 8 deaths {13.8%} vs. ‘after-hours,' 4 deaths {6.9%}, p = 0.36). Perfusion, cross-clamp, and circulatory arrest times did not differ between groups, nor did the types of aortic repairs performed. Postoperative complications were also comparable, including stroke, reoperation for bleeding, and new-onset renal failure requiring dialysis. Conclusions Thirty-day mortality and major morbidity after acute type A dissection repair are independent of when the operation is performed. Expeditious surgical intervention is still recommended for all primary acute type A dissection, irrespective of time of day.