Is There a Weekend Effect in Surgery for Type A Dissection?: Results From the Nordic Consortium for Acute Type A Aortic Dissection Database

Ahlsson, Anders; Wickbom, Anders; Geirsson, Arnar; Franco‐Cereceda, Anders; Kazemi, Ahmad; Gunn, Jarmo; Hansson, Emma C.; Hjortdal, Vibeke E.; Järvelä, Kati; Jeppsson, Anders; Mennander, Ari; Nozohoor, Shahab; Pan, Emily; Zindovic, Igor; Guðbjartsson, Tómas; Olsson, Christian

doi:10.1016/j.athoracsur.2019.03.005

Cited by 41 publications

(41 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of these, 195 articles were excluded after the inclusion and exclusion criteria were applied. Full text of the remaining 45 papers was screened, yielding six studies to be included in the systematic review and meta‐analysis 8‐13 . The PRISMA flow chart illustrates these search results in Figure S1.…”

Section: Resultsmentioning

confidence: 99%

“…Other studies included in this systematic review did not adequately control and report on this factor. 8,10,11,13 Therefore, we acknowledge that these factors are potential confounders within this systematic review and could be further improved upon in future studies. 14,15,32 Overall, this study suggests that postoperative outcomes were comparable in IH and OOH surgery for ATAAD, with IH surgery being marginally superior for having lower 30-day mortality and AKI rates.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Acute type A aortic dissection in‐hours versus out‐of‐hours: A systematic review and meta‐analysis

et al. 2020

View full text Add to dashboard Cite

Objective: We sought to compare clinical outcomes in patients with acute type A aortic dissection that undergone surgical repair during in-hours (IH) versus out-ofhours (OOH). Methods: An electronic literature search was done till March 2020 to include studies with comparative cohorts of IH versus OOH. Primary outcomes were 30-day mortality, stroke, and reoperation for bleeding; secondary outcomes were acute kidney injury, total hospital stay, and intensive care unit stay. Results: Six articles with a total of 3744 patients met the inclusion criteria. Mean age was similar, 60 ± 12 versus 60 ± 13 in IH versus OOH (p = .25). Aortic root and total arch replacement were similar in both cohorts, 22% in IH versus 25% in OOH

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute type A aortic dissection in‐hours versus out‐of‐hours: A systematic review and meta‐analysis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Recent data from the Nordic Consortium for acute type A aortic dissection registry 14 showed no difference in 30‐day mortality for patients with TAAAD who had operations at night and on the weekends versus patients who had operations during the day and on the weekdays, respectively. Our study corroborates these findings in a much larger, international sample.…”

Section: Commentmentioning

confidence: 99%

Time of day does not influence outcomes in acute type A aortic dissection: Results from the IRAD

Arnaoutakis

Bianco

Estrera³

et al. 2020

J Card Surg

View full text Add to dashboard Cite

Background: Type A acute aortic dissection (TAAAD) represents a surgical emergency requiring intervention regardless of time of day. Whether such a "evening effect" exists regarding outcomes for TAAAD has not been previously studied using a large registry data. Methods: Patients with TAAAD were identified from the International Registry of Acute Aortic Dissections (1996-2019). Outcomes were compared between patients undergoing operative repair during the daytime (D), defined as 8 am-5 pm, versus the evening (N), defined as 5 pm-8 am. Results: Four thousand one-hundrd and ninety-seven surgically treated patients with TAAAD were identified, with 1824 patients undergoing daytime surgery (43.5%) and 2373 patients undergoing evening surgery (56.5%). Daytime patients were more likely to have undergone prior cardiac surgery (13.2% vs. 9.5%; p < .001) and have had a prior aortic dissection (4.8% vs. 3.4%; p = .04). Evening patients were more likely to have been transferred from a referring hospital (70.8% vs. 75.0%; p = .003). Daytime patients were more likely to undergo aortic valve sparing root procedures (23.3% vs. 19.2%; p = .035); however, total arch replacement was performed with equal frequency (19.4% vs. 18.8%; p = .751). In-hospital mortality (D: 17.3% vs. N. 16.2%; p = .325) was similar between both groups. Subgroup analysis examining the effect of weekend presentation revealed no significant mortality difference. Conclusions: A majority of TAAAD patients underwent surgical repair at night. There were higher rates of postoperative tamponade in evening patients; however, mortality was similar. The expertise of cardiac-dedicated operative and critical care teams regardless of time of day as well as training paradigms may explain similar mortality outcomes in this high risk population.

show abstract

“…One might argue that for crucial surgeries like acute aortic dissection, where the mortality rate is as high as 1% to 2% per hour in the first 24 hours [ 28 ] and 20% of patients die before reaching the hospital, [ 29 ] or for different types of transplant surgeries, the consequences might be different. However, some papers [ 30 , 31 ] have concluded that the time of day of the surgery has no significant effect in acute aortic dissection type A surgery. On the contrary, higher mortality was found in the longer time interval from hospital arrival to computed tomography scanning in blunt traumatic aortic injury, [ 32 ] which is the second leading cause of death for trauma patients.…”

Section: Discussionmentioning

confidence: 99%

Will surgeries performed at night lead to worse outcomes? Findings from a trauma center in Riyadh

et al. 2020

View full text Add to dashboard Cite

As surgeries are performed around the clock, the time of surgery might have an impact on outcomes. Our aim is to investigate the impact of daytime and nighttime shifts on surgeons and their performance. We believe that such studies are important to enhance the quality of surgeries and their outcomes and help understand the effects of time of the day on surgeons and the surgeries they perform. A retrospective cohort study was conducted using the database from the King Abdulaziz Medical City trauma center. We selected 330 cases of patients between 2015 and 2018, who underwent a trauma intervention surgery within 24 hours after admission. Patients were aged 15 years and above who underwent 1 or more of the following trauma interventions: neurosurgery, general surgery, plastic surgery, vascular surgery, orthopedics, ophthalmology, and/or otolaryngology. We divided the work hours into 3 shifts: 8 am to 3:59 pm , 4 pm to 11:59 pm , and midnight to 7:59 am . Participants’ mean age was 31.4 (standard deviation ± 13) years. Most surgeries occurred on weekdays (68.4%). Complications were one and a half times more on weekends, with 5 complicated cases on weekends (1.55%) and 3 (0.9%) on weekdays. Half of all surgeries were performed in the morning (152 cases, 53.15%); 73 surgeries (25.5%) were performed in the evening and 61 (21.3%) were performed late at night. Surgeries performed during late-night shifts were marginally better. Complications occurred in 4 out of 152 morning surgeries (2.6%), 2 out of 73 evening surgeries (2.7%), and only 1 out of 61 late-night surgeries (1.6%). The earlier comparison scored a P -value of >.99, suggesting that patients in morning and evening surgeries were twice more likely to experience complications than late-night surgeries. This study may support previous research that there is little difference in outcomes between daytime and nighttime surgeries. The popular belief that rested physicians are better physicians requires further assessment and research.

show abstract

Is There a Weekend Effect in Surgery for Type A Dissection?: Results From the Nordic Consortium for Acute Type A Aortic Dissection Database

Cited by 41 publications

References 17 publications

Acute type A aortic dissection in‐hours versus out‐of‐hours: A systematic review and meta‐analysis

Acute type A aortic dissection in‐hours versus out‐of‐hours: A systematic review and meta‐analysis

Time of day does not influence outcomes in acute type A aortic dissection: Results from the IRAD

Will surgeries performed at night lead to worse outcomes? Findings from a trauma center in Riyadh

Contact Info

Product

Resources

About