Long-Term Survival after Surgery for Type A Aortic Dissection: A Propensity-Matched Analysis for Nighttime versus Daytime Surgery in 1,163 Patients

Objectives: Acute type A aortic dissection (TAAD) is a complex disease with a high risk for perioperative mortality. “Nighttime surgery” was recently described as an independent risk factor for perioperative mortality. There are no data about “nighttime surgery” being a risk factor for long-term mortality. Aim of this study is to report long-term mortality rates after surgery for TAAD depending on the time of the surgery (day vs. night).

Methods: We retrospectively screened a single-center aortic dissection database. The inclusion criteria were (1) acute type A (Stanford) aortic dissection between 01/2000 and 12/2019, (2) surgery for TAAD, (3) complete imaging and clinical reports. Daytime surgery (ds) was defined as start of the operation between 7 a.m. and 4 p.m., and nighttime surgery (ns) between 4 p.m. and 7 a.m.. To account imbalances, we performed a 1:1 propensity matching using nearest neighbor algorithm.

Result: A total of 1,103 patients were included in this analysis. The measured intraoperative times, total operative duration (ds: 435 ± 150 vs. ns: 445 ± 162 minutes, p = 0.258), bypass (ds: 233 ± 92 vs. ns: 236 ± 95 minutes, p = 0.521), and cross-clamp time (ds: 106 ± 39 vs. ns: 107 ± 36 minutes, p = 0.689) had the tendency to be longer during nighttime, but were not statistically different between the nighttime and the daytime group. Postoperative parameters such as the total number of revisions (ds: 206 [39%] vs. ns: 231 [40%], p = 0.768), open chest therapy (ds: 57 (11%) vs. ns: 47 (8%), p = 0.092) or the need for tracheotomy (ds: 91 (18%) vs. ns: 120 (21%), p = 0.215) were not statistically different. The propensity score matching of preoperative parameters resulted in 457 patients in both groups (daytime vs. nighttime group). Long-term survival after surgery for ATAAD showed no relevant difference between the daytime and the nighttime surgery groups (ds: 101 [23.7%] vs. ns: 99 [23.5%], p = 0.48, McNemar).

Conclusion: The results of this study support the guideline recommendation for urgent surgical treatment irrespective of the time of day.

Publication History

Article published online:
19 February 2021