Objective To compare surgical outcomes of Stanford type A acute aortic dissection between operations at midnight and daytime. Methods From January 2004 to March 2013，195 patients with Stanford type A acute aortic dissection received surgical treatment in Nanjing Hospital Affiliated to Nanjing Medical University （Nanjing Cardiovascular Disease Hospital）. Patients with identical or similar propensity scores were matched from 127 patients who underwent emergency operation at daytime and 68 patients who underwent emergency operation at midnight. A total of 58 pairs of matched patients which had the same or similar propensity score were selected in daytime surgery group （n=58，43 males and 15 females，47.7±14.6 years） and midnight surgery group （n=58，45 males and 13 females，48.3±14.6 years）. Operation time，postoperative chest drainage，mechanical ventilation time，postoperative incidence of dialysis and tracheostomy，length of ICU stay and in-hospital mortality were compared between the daytime group and midnight group. Results A total of 58 pair of patients were matched in this study. There was no statistical difference in postoperative incidence of tracheostomy ［19.0% （11/58） vs. 6.9% （4/58），P=0.053］ or in-hospital mortality ［8.6% （5/58） vs. 6.9%（4/58），P=0.729］ between the midnight group and daytime group. Operation time （485.7±93.5 minutes vs. 428.5±123.3 minutes，P=0.048），postoperative chest drainage （979.5±235.7 ml vs. 756.6±185.9 ml，P=0.031），mechanical ventilation time （67.9±13.8 hours vs. 55.7±11.9 hours，P=0.025），postoperative incidence of dialysis ［17.2% （10/58） vs. 5.2%（3/58），P=0.039］ and length of ICU stay （89.4±16.2 hours vs. 74.8±12.5 hours，P=0.023） of the midnight group weresignificantly longer or higher than those of the daytime group. A total of 107 patients were followed up for 4-6 months after discharge. During follow-up，there was no late death. Among the 13 patients who required postoperative dialysis，12 patientsno longer needed regular dialysis. Conclusion Emergency operation at midnight does not increase in-hospital mortalitybut increase some postoperative morbidity in patients with Stanford type A acute aortic dissection. Whether at midnight or daytime，better preoperative preparation and surgeons’ vigor are needed for timely surgical treatment for patients with Stanford type A acute aortic dissection.
Citation：
QIN Wei,HUANG Fuhua,XIAO Liqiong,LIU Shengchen,CHEN Xin.. Emergency Operation at Midnight Does Not Increase In-hospital Mortality in Patients with Acute Aortic Dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(5): 542-545. doi: 10.7507/1007-4848.20130170
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Ahmed A， Aban IB， Vaccarino V， et al. A propensity-matched study of the effect of diabetes on the natural history of heart failure：variations by sex and age. Heart， 2007， 93 （12）：1584-1590.
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Legras A， Bruzzi M， Nakashima K， et al. Risk factors for hospital death after surgery for type A aortic dissection. Asian Cardiovasc Thorac Ann， 2012， 20 （3）：269-274.
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Long SM， Tribble CG， Raymond DP， et al. Preoperative shock determines outcome for acute type A aortic dissection. Ann Thorac Surg， 2003， 75 （2）：520-524.
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Stefanidis C， Sanoussi A， Demanet H， et al. Acute myocardial nfarction due to an acute aortic dissection. Rev Med Brux， 2011， 32 （3）：179-181.
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Camaro C， Wouters NT， Gin MT， et al. Acute myocardial infarctionwith cardiogenic shock in a patient with acute aortic dissection. Am J Emerg Med， 2009， 27 （7）：899.
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Austin PC， Mamdani MM. A comparison of propensity score methods：a case-study estimating the effectiveness of post-AMI statin use. Stat Med， 2006， 25 （12）：2084-2106.
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- 1. Liden H， Wiklund L， Haraldsson A， et al. Temporary circulatory support with extra corporeal membrane oxygenation in adults with refractory cardiogenic shock. Scand Cardiovasc J， 2009， 43 （4）：226-232.
- 2. Ahmed A， Aban IB， Vaccarino V， et al. A propensity-matched study of the effect of diabetes on the natural history of heart failure：variations by sex and age. Heart， 2007， 93 （12）：1584-1590.
- 3. 王永吉， 蔡宏伟， 夏结来， 等. 倾向指数第一讲倾向指数的基本概念和研究步骤. 中华流行病学杂志， 2010， 31 （3）：347-348.
- 4. 王永吉， 蔡宏伟， 夏结来， 等. 倾向指数第二讲：常用研究方法. 中华流行病学杂志， 2010， 31 （5）：584-585.
- 5. 陈鑫， 黄福华， 徐明， 等. 孙氏手术治疗急性Stanford A型主动脉夹层. 中华胸心血管外科杂志， 2012， 28 （6）：333-335.
- 6. 陶登顺， 王辉山， 姜辉， 等. De Bakey I型主动脉夹层的外科治疗. 中国胸心血管外科临床杂志， 2011， 18 （3）：218-221.
- 7. Hagan PG， Nienaber CA， Isselbacher EM， et al. The international registry of acute aortic dissection （IRAD）：new insights into an old disease. JAMA， 2000， 283 （7）：897-903.
- 8. 邱志兵， 陈鑫， 徐明， 等. 急性Stanford A型主动脉夹层的外科治疗. 中国胸心血管外科临床杂志， 2007， 14 （6）：426-428.
- 9. 熊玮， 董少红. 急性主动脉夹层院内死亡的危险因素分析. 中华高血压杂志， 2011， 19 （6）：584-586.
- 10. Santini F， Montalbano G， Casali G， et al. Clinical presentation is the main predictor of in-hospital death for patients with acute type A aortic dissection admitted for surgical treatment：a 25 years experience.Int J Cardiol， 2007， 115 （3）：305-311.
- 11. Legras A， Bruzzi M， Nakashima K， et al. Risk factors for hospital death after surgery for type A aortic dissection. Asian Cardiovasc Thorac Ann， 2012， 20 （3）：269-274.
- 12. Long SM， Tribble CG， Raymond DP， et al. Preoperative shock determines outcome for acute type A aortic dissection. Ann Thorac Surg， 2003， 75 （2）：520-524.
- 13. Stefanidis C， Sanoussi A， Demanet H， et al. Acute myocardial nfarction due to an acute aortic dissection. Rev Med Brux， 2011， 32 （3）：179-181.
- 14. Camaro C， Wouters NT， Gin MT， et al. Acute myocardial infarctionwith cardiogenic shock in a patient with acute aortic dissection. Am J Emerg Med， 2009， 27 （7）：899.
- 15. Linden A， Adams JL. Combining the regression discontinuity design and propensity score-based weighting to improve causal inference in program evaluation. J Eval Clin Pract， 2012， 18 （2）：317-325.
- 16. Austin PC， Mamdani MM. A comparison of propensity score methods：a case-study estimating the effectiveness of post-AMI statin use. Stat Med， 2006， 25 （12）：2084-2106.
- 17. Gallerani M， Imberti D， Bossone E， et al. Higher mortality in patientshospitalized for acute aortic rupture or dissection during weekends. J Vasc Surg， 2012， 55 （5）：1247-1254.
- 18. Kostis WJ， Demissie K， Marcella SW， et al. Weekend versus weekdayadmission and mortality from myocardial infarction. N Engl J Med， 2007， 356 （11）：1099-1109.
