Impact of Age on Survival After Acute Type A Aortic Dissection Repair

Acute Type A aortic dissection (ATAAD) remains a surgical emergency with high morbidity and mortality despite improvements in operative management. The influence of age on outcomes among patients undergoing surgical repair remains incompletely characterized.

Using the Nationwide Inpatient Sample (2010-2018, 2020), we identified adult hospitalizations with a primary diagnosis of ATAAD who underwent surgical repair. Patients were stratified into 3 age groups (<65, 66-75, and >75 years). Weighted analyses compared demographics, comorbidities, hospital characteristics, and outcomes across groups. Multivariable logistic regression identified independent predictors of in-hospital mortality, adjusting for comorbidities and hospital factors.

Among 32,798 weighted admissions, 48.1% were aged <65 years, 23.3% were 66-75 years, and 28.6% were >75 years (median age 65 years). Overall, in-hospital mortality was 11.9%, increasing from 8.9% in younger patients to 17.1% in those >75 years (P < 0.001). Older adults had greater comorbidity burden (with most comorbidities differing significantly), shorter median length of stay (5 vs. 6 days, P < 0.001), and lower total hospital charges (P < 0.001). On multivariable analysis, age remained an independent predictor of mortality in patients 66-75 years old (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.34-1.63; P < 0.001) and in patients >75 years (OR, 2.29; 95% CI, 2.10-2.5; P < 0.001). Larger hospitals demonstrated modestly higher adjusted mortality, while hospital teaching status was not independently associated with outcomes.

Advancing age substantially increases in-hospital mortality after ATAAD repair. These findings emphasize the need for individualized operative decision-making, early referral to experienced centers, and system-level strategies to optimize outcomes for older adults with ATAAD.