Outcomes of Acute Type A Aortic Dissection repair: Day-time versus Night-time

Abstract Objective We sought to report our experience of repairing acute type A aortic dissection (ATAAD) over 21 years during in-hours vs out-of-hours prior to and after the establishment of specialised aortic service and rota in 2007. Methods A retrospective analysis of all patients that underwent acute type A aortic dissection repair between November 1998 to December 2019 in our centre. Within hours were defined as 08:00 to 19:59 hours and out of hours were defined as 20:00 to 07:59 hours. Results A total of 286 patients underwent repair of ATAAD. 80 operations took place in the pre-rota period (43 operations in-hours, 37 out-of-hours) and 206 operations in the specialised rota period (110 in-hours, 96 out-of-hours). There was no difference in 30-day mortality between the in-hours and out-of-hours groups in either the pre-rota (23.3% v 32.4%, p=0.36) or specialised rota periods (11.6% v 11.5%, p=0.94). Mean number of cases per year increased by 83% between the pre-rota and specialised rota periods. 30-day mortality reduced in both the in-hours (23.3% v 11.6%) and out-of-hours (32.4% v 11.5%) groups, since the introduction of the specialised aortic rota. Conclusion Outcomes in repair of acute type A aortic dissection during in-hours and out-of-hours are similar when operated on in a specialised unit with a dedicated aortic team. This emphasises the current global trend of service centralisation without particular attention to time of the day to operate on such critical cohort patients.