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

Anders Ahlsson; Anders Wickbom; Arnar Geirsson; Anders Franco-Cereceda; Khalil Ahmad; Jarmo Gunn; Emma C Hansson; Vibeke Hjortdal; Kati Jarvela; Anders Jeppsson; Ari Mennander; Shahab Nozohoor; Emily Pan; Igor Zindovic; Tomas Gudbjartsson; Christian Olsson

doi:10.1016/j.athoracsur.2019.03.005

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

Anders Ahlsson, Anders Wickbom, Arnar Geirsson, Anders Franco-Cereceda, Khalil Ahmad, Jarmo Gunn, Emma C Hansson, Vibeke Hjortdal, Kati Jarvela, Anders Jeppsson, Ari Mennander, Shahab Nozohoor, Emily Pan, Igor Zindovic, Tomas Gudbjartsson, Christian Olsson

Abstract

BACKGROUND: Aortic dissection type A requires immediate surgery. In general surgery populations, patients operated on during weekends have higher mortality rates compared with patients whose operations occur on weekdays. The weekend effect in aortic dissection type A has not been studied in detail.

METHODS: The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) registry includes data for 1,159 patients who underwent type A dissection surgery at 8 Nordic centers during 2005 to 2014. This study is based on data relating to surgery conducted during weekdays versus weekends and starting between 8:00 am and 8:00 pm ("daytime") versus from 8:00 pm to 8:00 am ("nighttime"), as well as time from symptoms, admittance, and diagnosis to surgery. The influence of timing of surgery on the 30-day mortality rate was assessed using logistic regression analysis.

RESULTS: The 30-day mortality was 18% (204 of 1,159), with no difference in mortality between surgery performed on weekdays (17% [150 of 889]) and on weekends (20% [54 of 270], p = 0.45), or during nighttime (19% [87 of 467]) versus daytime (17% [117 of 680], p = 0.54). Time from symptoms to surgery (median 7.0 hours vs 6.5 hours, p = 0.31) did not differ between patients who survived and those who died at 30 days. Multivariable regression analysis of risk factors for 30-day mortality showed no weekend effect (odds ratio, 1.04; 95% confidence interval, 60.67 to 1.60; p = 0.875), but nighttime surgery was a risk factor (odds ratio, 2.43; 95% confidence interval, 1.29 to 4.56; p = 0.006).

CONCLUSIONS: The 30-day mortality in surgical repair of aortic dissection type A was not significantly affected by timing of surgery during weekends versus weekdays. Nighttime surgery seems to predict increased 30-day mortality, after correction for other risk factors.

Original language	English
Journal	The Annals of thoracic surgery
Volume	108
Issue number	3
Pages (from-to)	770-776
Number of pages	7
ISSN	0003-4975
DOIs	https://doi.org/10.1016/j.athoracsur.2019.03.005
Publication status	Published - Sept 2019
Externally published	Yes

Keywords

Acute Disease
After-Hours Care
Aged
Aneurysm, Dissecting/diagnostic imaging
Aortic Aneurysm, Thoracic/diagnostic imaging
Cause of Death
Cohort Studies
Databases, Factual
Emergency Treatment/methods
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Postoperative Complications/epidemiology
Proportional Hazards Models
Registries
Retrospective Studies
Scandinavian and Nordic Countries
Survival Analysis
Time Factors

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10.1016/j.athoracsur.2019.03.005

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Ahlsson, A., Wickbom, A., Geirsson, A., Franco-Cereceda, A., Ahmad, K., Gunn, J., Hansson, E. C., Hjortdal, V., Jarvela, K., Jeppsson, A., Mennander, A., Nozohoor, S., Pan, E., Zindovic, I., Gudbjartsson, T., & Olsson, C. (2019). Is There a Weekend Effect in Surgery for Type A Dissection? Results From the Nordic Consortium for Acute Type A Aortic Dissection Database. The Annals of thoracic surgery, 108(3), 770-776. https://doi.org/10.1016/j.athoracsur.2019.03.005

Ahlsson, A, Wickbom, A, Geirsson, A, Franco-Cereceda, A, Ahmad, K, Gunn, J, Hansson, EC, Hjortdal, V, Jarvela, K, Jeppsson, A, Mennander, A, Nozohoor, S, Pan, E, Zindovic, I, Gudbjartsson, T & Olsson, C 2019, 'Is There a Weekend Effect in Surgery for Type A Dissection? Results From the Nordic Consortium for Acute Type A Aortic Dissection Database', The Annals of thoracic surgery, vol. 108, no. 3, pp. 770-776. https://doi.org/10.1016/j.athoracsur.2019.03.005

@article{c17d0f7ea4f84ae98c05e79f76983f6f,

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

abstract = "BACKGROUND: Aortic dissection type A requires immediate surgery. In general surgery populations, patients operated on during weekends have higher mortality rates compared with patients whose operations occur on weekdays. The weekend effect in aortic dissection type A has not been studied in detail.METHODS: The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) registry includes data for 1,159 patients who underwent type A dissection surgery at 8 Nordic centers during 2005 to 2014. This study is based on data relating to surgery conducted during weekdays versus weekends and starting between 8:00 am and 8:00 pm ({"}daytime{"}) versus from 8:00 pm to 8:00 am ({"}nighttime{"}), as well as time from symptoms, admittance, and diagnosis to surgery. The influence of timing of surgery on the 30-day mortality rate was assessed using logistic regression analysis.RESULTS: The 30-day mortality was 18% (204 of 1,159), with no difference in mortality between surgery performed on weekdays (17% [150 of 889]) and on weekends (20% [54 of 270], p = 0.45), or during nighttime (19% [87 of 467]) versus daytime (17% [117 of 680], p = 0.54). Time from symptoms to surgery (median 7.0 hours vs 6.5 hours, p = 0.31) did not differ between patients who survived and those who died at 30 days. Multivariable regression analysis of risk factors for 30-day mortality showed no weekend effect (odds ratio, 1.04; 95% confidence interval, 60.67 to 1.60; p = 0.875), but nighttime surgery was a risk factor (odds ratio, 2.43; 95% confidence interval, 1.29 to 4.56; p = 0.006).CONCLUSIONS: The 30-day mortality in surgical repair of aortic dissection type A was not significantly affected by timing of surgery during weekends versus weekdays. Nighttime surgery seems to predict increased 30-day mortality, after correction for other risk factors.",

keywords = "Acute Disease, After-Hours Care, Aged, Aneurysm, Dissecting/diagnostic imaging, Aortic Aneurysm, Thoracic/diagnostic imaging, Cause of Death, Cohort Studies, Databases, Factual, Emergency Treatment/methods, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Multivariate Analysis, Postoperative Complications/epidemiology, Proportional Hazards Models, Registries, Retrospective Studies, Scandinavian and Nordic Countries, Survival Analysis, Time Factors",

author = "Anders Ahlsson and Anders Wickbom and Arnar Geirsson and Anders Franco-Cereceda and Khalil Ahmad and Jarmo Gunn and Hansson, {Emma C} and Vibeke Hjortdal and Kati Jarvela and Anders Jeppsson and Ari Mennander and Shahab Nozohoor and Emily Pan and Igor Zindovic and Tomas Gudbjartsson and Christian Olsson",

year = "2019",

month = sep,

doi = "10.1016/j.athoracsur.2019.03.005",

language = "English",

volume = "108",

pages = "770--776",

journal = "The Annals of thoracic surgery",

issn = "0003-4975",

publisher = "Elsevier Inc",

number = "3",

}

TY - JOUR

T1 - Is There a Weekend Effect in Surgery for Type A Dissection?

T2 - Results From the Nordic Consortium for Acute Type A Aortic Dissection Database

AU - Ahlsson, Anders

AU - Wickbom, Anders

AU - Geirsson, Arnar

AU - Franco-Cereceda, Anders

AU - Ahmad, Khalil

AU - Gunn, Jarmo

AU - Hansson, Emma C

AU - Hjortdal, Vibeke

AU - Jarvela, Kati

AU - Jeppsson, Anders

AU - Mennander, Ari

AU - Nozohoor, Shahab

AU - Pan, Emily

AU - Zindovic, Igor

AU - Gudbjartsson, Tomas

AU - Olsson, Christian

PY - 2019/9

Y1 - 2019/9

N2 - BACKGROUND: Aortic dissection type A requires immediate surgery. In general surgery populations, patients operated on during weekends have higher mortality rates compared with patients whose operations occur on weekdays. The weekend effect in aortic dissection type A has not been studied in detail.METHODS: The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) registry includes data for 1,159 patients who underwent type A dissection surgery at 8 Nordic centers during 2005 to 2014. This study is based on data relating to surgery conducted during weekdays versus weekends and starting between 8:00 am and 8:00 pm ("daytime") versus from 8:00 pm to 8:00 am ("nighttime"), as well as time from symptoms, admittance, and diagnosis to surgery. The influence of timing of surgery on the 30-day mortality rate was assessed using logistic regression analysis.RESULTS: The 30-day mortality was 18% (204 of 1,159), with no difference in mortality between surgery performed on weekdays (17% [150 of 889]) and on weekends (20% [54 of 270], p = 0.45), or during nighttime (19% [87 of 467]) versus daytime (17% [117 of 680], p = 0.54). Time from symptoms to surgery (median 7.0 hours vs 6.5 hours, p = 0.31) did not differ between patients who survived and those who died at 30 days. Multivariable regression analysis of risk factors for 30-day mortality showed no weekend effect (odds ratio, 1.04; 95% confidence interval, 60.67 to 1.60; p = 0.875), but nighttime surgery was a risk factor (odds ratio, 2.43; 95% confidence interval, 1.29 to 4.56; p = 0.006).CONCLUSIONS: The 30-day mortality in surgical repair of aortic dissection type A was not significantly affected by timing of surgery during weekends versus weekdays. Nighttime surgery seems to predict increased 30-day mortality, after correction for other risk factors.

AB - BACKGROUND: Aortic dissection type A requires immediate surgery. In general surgery populations, patients operated on during weekends have higher mortality rates compared with patients whose operations occur on weekdays. The weekend effect in aortic dissection type A has not been studied in detail.METHODS: The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) registry includes data for 1,159 patients who underwent type A dissection surgery at 8 Nordic centers during 2005 to 2014. This study is based on data relating to surgery conducted during weekdays versus weekends and starting between 8:00 am and 8:00 pm ("daytime") versus from 8:00 pm to 8:00 am ("nighttime"), as well as time from symptoms, admittance, and diagnosis to surgery. The influence of timing of surgery on the 30-day mortality rate was assessed using logistic regression analysis.RESULTS: The 30-day mortality was 18% (204 of 1,159), with no difference in mortality between surgery performed on weekdays (17% [150 of 889]) and on weekends (20% [54 of 270], p = 0.45), or during nighttime (19% [87 of 467]) versus daytime (17% [117 of 680], p = 0.54). Time from symptoms to surgery (median 7.0 hours vs 6.5 hours, p = 0.31) did not differ between patients who survived and those who died at 30 days. Multivariable regression analysis of risk factors for 30-day mortality showed no weekend effect (odds ratio, 1.04; 95% confidence interval, 60.67 to 1.60; p = 0.875), but nighttime surgery was a risk factor (odds ratio, 2.43; 95% confidence interval, 1.29 to 4.56; p = 0.006).CONCLUSIONS: The 30-day mortality in surgical repair of aortic dissection type A was not significantly affected by timing of surgery during weekends versus weekdays. Nighttime surgery seems to predict increased 30-day mortality, after correction for other risk factors.

KW - Acute Disease

KW - After-Hours Care

KW - Aged

KW - Aneurysm, Dissecting/diagnostic imaging

KW - Aortic Aneurysm, Thoracic/diagnostic imaging

KW - Cause of Death

KW - Cohort Studies

KW - Databases, Factual

KW - Emergency Treatment/methods

KW - Female

KW - Humans

KW - Kaplan-Meier Estimate

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Postoperative Complications/epidemiology

KW - Proportional Hazards Models

KW - Registries

KW - Retrospective Studies

KW - Scandinavian and Nordic Countries

KW - Survival Analysis

KW - Time Factors

U2 - 10.1016/j.athoracsur.2019.03.005

DO - 10.1016/j.athoracsur.2019.03.005

M3 - Journal article

C2 - 30953648

SN - 0003-4975

VL - 108

SP - 770

EP - 776

JO - The Annals of thoracic surgery

JF - The Annals of thoracic surgery

IS - 3

ER -

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

Abstract

Keywords

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