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Acute type A aortic dissection in‐hours versus out‐of‐hours: A systematic review and meta‐analysis
Author(s) -
Toh Steven,
Yew Dominic Choon Men,
Choong Jia Jin,
Chong Tze Lin,
Harky Amer
Publication year - 2020
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.15070
Subject(s) - medicine , confidence interval , aortic dissection , relative risk , stroke (engine) , intensive care unit , meta analysis , surgery , inclusion and exclusion criteria , aorta , mechanical engineering , alternative medicine , pathology , engineering
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‐of‐hours (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 (risk ratio [RR], 1.10; 95% confidence interval [CI: 0.78, 1.55]; p = .58) and 29% in IH versus 32% in OOH (RR, 0.96; 95% CI [0.89, 1.04], p = .37) respectively. Reoperation for bleeding and stroke rate were similar, with 18% in IH versus 23% in OOH (RR, 0.89; 95% CI [0.73, 1.08]; p = .24), and 12% in IH versus 13% in OOH (RR, 0.83; 95% CI [0.66, 1.03]; p = .09) respectively. Thirty‐day mortality was significantly lower in IH (RR, 0.81; 95% CI [0.72, 0.90]; p = .0001). Conclusion There was higher 30‐day mortality rate during OOH surgery, yet this difference diminished following sensitivity analysis. There were no significant differences in major postoperative outcomes. Therefore, operating on such cases should be decided on clinical priority without delay.