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.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021