Type A acute aortic dissection repair during night time: is it safe?

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Disease Management

Background:

• Belief that out-of-hours surgery increases complications and mortality.
• Lack of data on time-of-day impact for type A acute aortic dissection (TAAD) repair.
• Need to evaluate operative outcomes and long-term survival based on surgical timing.

Purpose of the Study:

• To compare operative outcomes and late survival of TAAD repair performed during regular daytime hours versus out-of-hours (night-time).
• To investigate the potential association between surgical timing and patient outcomes in TAAD.
• To challenge the perception of increased risk for night-time emergency surgeries.

Main Methods:

• Observational study using prospectively collected data from 196 patients undergoing emergency TAAD repair.
• Patients stratified into daytime (7 AM–7 PM, n=124) and night-time (7 PM–7 AM, n=72) groups.
• Inverse propensity score weighting used to model causal effects and assess the impact of procedure timing on outcomes.

Main Results:

• No significant differences in operative mortality (8.3% vs 17.3%), re-exploration (12.5% vs 9.7%), or neurological deficit (18.1% vs 16.9%) between night-time and day-time TAAD repair.
• Overall 30-day mortality was 14.3% (28 patients).
• Long-term survival at a mean 9-year follow-up was comparable between the two groups (adjusted log-rank P=0.28).

Conclusions:

• Night-time surgical repair of type A acute aortic dissection (TAAD) is not associated with increased operative complications or mortality.
• Outcomes for TAAD repair are similar regardless of whether the procedure is performed during day or night hours.
• The study suggests that surgical timing does not negatively impact TAAD patient survival.