Regional travel distance is not associated with operative mortality in acute type A aortic dissection

Few data are available to examine the impact of travel distance on outcomes in acute type A aortic dissection (ATAAD). We hypothesized that longer travel would increase mortality after ATAAD repair.

We studied the impact of travel distance ≤100 miles before ATAAD repair between July 2011 and September 2022 using a regional collaborative database. Patients were stratified into quartiles, and the longest and shortest distance quartiles were compared. High-volume centers were defined as those averaging >10 ATAAD repairs annually. Multivariable and hierarchical logistic regression models were fit to identify preoperative and intraoperative risk factors associated with operative mortality.

We identified 1285 patients who underwent ATAAD repair: 320 in the longest-distance quartile and 335 in the shortest. The longest-distance quartile had greater hospital transfer rates (76% vs 26%, P < .001). There was no difference in major morbidity (52% vs 53%, P = .78) or operative mortality (22% vs 22%, P = .95). High-volume centers were associated with lower mortality (odds ratio [OR], 0.68; 95% CI, 0.46-0.99; P = .048). Age (OR, 1.03; 95% CI, 1.01-1.04, P < .001), cardiopulmonary resuscitation (OR, 2.73; 95% CI, 1.31-5.69, P = .007), cardiogenic shock (OR, 1.99; 95% CI, 1.24-3.22, P = .005), longer cardiopulmonary bypass time (OR, 1.01; 95% CI, 1.01-1.01, P < .001), greater temperature nadir (OR, 1.05; 95% CI, 1.01-1.09, P = .006), and intraoperative blood transfusion (OR, 1.16; 95% CI, 1.08-1.24, P < .001) were associated with greater mortality. Distance (OR, 0.99; 95% CI, 0.98-1.00; P = .073) and hospital transfers (OR, 1.08 95% CI, 0.74-1.58; P = .69) were nonsignificant.

Hospital transfers and travel distances up to 100 miles for ATAAD repair did not increase operative mortality.