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

Background: Out-of-hours work is believed to lead to a higher complication rate and mortality after surgery. However, there is no data supporting this perception in type A acute aortic dissections (TAAD) repair. We present an observational study of prospectively collected data comparing operative outcomes and late survival of TAAD repair performed after hours versus regular daytime working hours.

Methods: A total of 196 patients undergoing emergency TAAD repair (mean age 59 ± 13 years, range 18–81, F/M 57/139) were included in the final analysis. Patients were stratified as daytime between 7 AM and 7 PM (n = 124), and night time between 7 PM and 7 AM (n = 72). Inverse propensity score (PS) weighting for modelling causal effects was used to assess the effect of time procedure on outcomes of interest.

Results: Overall 30-day mortality was 14.3% (28 patients). No significant differences were found between the night-time and day-time groups with regard to operative mortality (8.3% versus 17.3%; adjusted OR 0.35; 95%CI 0.12–1.04; P = 0.06), re-exploration (12.5% versus 9.7%; adjusted OR 2.09; 95%CI 0.72–6.07; P = 0.18) and neurological deficit (18.1% versus 16.9%; adjusted OR 0.91; 95%CI 0.33–2.54; P = 0.87). Long-term survival at mean 9 years follow-up was comparable between the two groups (adjusted log-rank P = 0.28).

Conclusions: Night-time surgical repair of TAAD when compared with day-time repair does not seem to be associated with a greater risk of surgical complications, operative mortality and long-term mortality.