Hospital mortality of patients aged 80 and older after surgical repair for type A acute aortic dissection in Japan

Abstract

To evaluate whether patients aged 80 and older have higher risk of hospital mortality after repair of type A acute aortic dissection (TAAAD).Emergency surgery for TAAAD in patients aged 80 and older remains a controversial issue because of its high surgical risk.Data from patients who underwent surgical repair of TAAAD between April 2011 and March 2013 were retrospectively extracted from the Japanese Diagnosis Procedure Combination database. The effect of age on hospital mortality was evaluated using multivariate logistic regression analysis.A total of 5175 patients were enrolled. The mean age of patients was 67.1 ± 13.0 years, and the male:female ratio was 51:49. Patients aged 80 and older more frequently received tracheostomy than their younger counterparts (9.5% vs 5.4%, P <0.001). Intensive care unit and hospital stays were significantly longer in the elderly cohort versus the younger cohort (7.6 vs 6.7 days, P <0.001, and 42.2 vs 35.8 days, P <0.001, respectively). Logistic regression analysis showed that age ≥80 years was significantly associated with a higher risk of hospital mortality (adjusted odds ratio, 1.62; 95% confidence interval, 1.28–2.06; P <0.001). In linear regression analysis, age ≥80 years was also significantly associated with longer hospital stay (P = 0.007).In a large, nationwide, Japanese database, patients aged 80 and older were at increased risk of hospital mortality and length of hospital stay.

Early and Late Surgical Outcomes of Acute Type A Aortic Dissection in Octogenarians

“…During the entire series, only 8 patients (0.7%) had prior cardiac surgery. According to the large survey of 5,175 ATAAD patients based on the Japanese health insurance database linked with a payment system, the prior surgery rate for Japanese ATAAD octogenarian patients is 0.3% [15]. This result is close to ours and to that of other Japanese literature [13].…”

“…There was no significant difference in the overall complication rates between groups (24.1% [27 of 112] for octogenarians versus 23.0% [211 of 914] for controls; (15), intestinal ischemia (13), multiple organ failure (9), rupture of the downstream aorta (9), bleeding (4), myocardial infarction (3), pneumonia (3), renal/liver failure (2), lower leg ischemia (1), and unknown (1). No statistically significant differences were found between the groups.…”

Factors affecting prolonged length of stay in psychiatric patients in Japan: A retrospective observational study

“…We conducted a retrospective observational study using the nationwide discharge administrative database, the DPC/PDPS system. The details of the DPC/PDPS have been described elsewhere . In short, the DPC/PDPS is a mixed‐case patient classification system that has been linked to payments at acute‐care and mixed‐care hospitals in Japan.…”

Impact of age on early outcomes and long-term survival of patients undergoing aortic repair with Stanford A dissection

“…Due to the increasing incidence of various comorbidities with increasing life expectancy, an age of 65 years may be a reasonable cut-off value despite the fact that some other studies chose 80 years in their analysis. 14,15 Our cohort was exactly bisected, comprising 120 patients in each group. AAD is a complex cardiovascular life-threatening disease 10,13,16-20 and affects approximately 3.5 per 100,000 persons per year.…”