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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
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In-Hospital Mortality of Patients With Acute Type A Aortic Dissection Hospitalized on Weekends Versus Weekdays
Toshiyuki Takahashi1,2, Hideaki Yoshino1, Koichi Akutsu1
1Tokyo CCU Network Scientific Committee, Tokyo, Japan.
JACC. Asia
|November 7, 2022
Summary
Weekend admissions for acute type A aortic dissection (ATAAD) initially showed higher mortality. However, a patient-transfer system improved outcomes, eliminating the weekend mortality difference in later years.
Area of Science:
- Cardiovascular Surgery
- Public Health
- Healthcare Systems
Background:
- Weekend admissions for acute aortic dissection are linked to increased mortality.
- The Tokyo metropolitan area implemented a patient-transfer system for aortic dissection.
Purpose of the Study:
- To investigate if weekend admissions for acute type A aortic dissection (ATAAD) correlate with higher in-hospital mortality.
- To assess the impact of a patient-transfer system on weekend ATAAD outcomes.
Main Methods:
- A retrospective study of 2,339 ATAAD patients across two cohorts (initial year and 2013-2015).
- Analysis of in-hospital mortality rates for weekend versus weekday admissions.
- Statistical adjustments using inverse probability weighting and multivariable analyses.
Main Results:
- In the initial cohort, weekend ATAAD admissions had significantly higher in-hospital mortality (OR: 2.28).
- In the later cohort, in-hospital mortality for weekend admissions decreased significantly (37.2% to 22.2%), with no significant difference compared to weekdays (OR: 0.96).
- Improved outcomes were associated with increased interfacility transfers and reduced mortality at non-high-volume centers.
Conclusions:
- A significant reduction in in-hospital mortality for weekend ATAAD admissions was observed.
- The patient-transfer system effectively mitigated the disparity in mortality between weekend and weekday admissions.
Keywords:
AAD, acute aortic dissectionATAAD, acute type A aortic dissectionCCU, cardiovascular care unitIMH, intramural hematomaIPW, inverse probability weightingTAAS, Tokyo Acute Aortic Super-networkacute aortic dissectionmortalitynetworktransferweekend effectMore Related Videos
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