"Overtime Hours Effect" on Emergency Surgery of Acute Type A Aortic Dissection

Abstract

ObjectiveTreatment of acute diseases of the aorta is still associated with high mortality and morbidity. It is believed that interventions for these diseases on overtime hours (night shifts or weekend shifts) may increase mortality. In this study, we investigated the effect of performing acute type A aortic dissection surgery on overtime hours in terms of postoperative outcomes.Methods206 patients who underwent emergency surgery for acute type A aortic dissection were retrospectively evaluated. Two groups were constituted: patients operated on daytime working hours (n=61), and patients operated on overtime hours (n=145), respectively.ResultsChronic obstructive pulmonary disease and repeat surgery were higher in group 1. There was no statistically significant difference between the two groups in terms of operative and postoperative results. Mortality rates and postoperative neurological complications in group 1 were 9.8% and 13.1%, respectively. In group 2, these rates were 13.8% and 12.4%, respectively (P=0.485 - P=0.890). Multivariate analysis identified that cross-clamp time, amount of postoperative drainage, preoperative loss of consciousness and postoperative neurological complications are the independent predictors of mortality.ConclusionsAs the surgical experience of the clinics improves, treatment of acute type A aortic dissections can be successfully performed both overtime and daytime working hours.

Acute type A aortic dissection in‐hours versus out‐of‐hours: A systematic review and meta‐analysis

“…We also explored the possibility of surgical teams having differing levels of experience in the IH and OOH groups. We noted that although Gokalp et al 9 was able to ensure that patients in both cohorts were operated by teams with similar levels of surgical experience, Narayan et al 12 were unable to account for the differences in surgical experience between the two groups in their study. Other studies included in this systematic review did not adequately control and report on this factor 8,10,11,13 .…”

“…In contrast, 30‐day mortality rate was found to be significantly lower in the IH cohort as compared with the OOH cohort ( n = 621 in IH vs. n = 334 in OOH cohort; RR, 0.81; 95% CI [0.72, 0.90]; p = .0001; Figure 3). Also, some studies 9,13 found that the complication of AKI was significantly lower in the IH cohort as compared with the OOH cohort ( n = 120 [27%] vs. n = 144 [31%]; RR, 0.80; 95% CI [0.65, 0.98]; p = .03, Figure S9). Only two studies 9,10 reported the total hospital stay and this was not different between the IH and OOH cohorts, 11.5 ± 12.5 in IH versus 11.0 ± 14.0 in OOH (WMD, 0.71; 95% CI [−2.20, 3.62]; p = .63; Figure 4).…”

“…There was no significant difference between the IH and OOH co- rate was found to be significantly lower in the IH cohort as compared with the OOH cohort (n = 621 in IH vs. n = 334 in OOH cohort; RR, 0.81; 95% CI [0.72, 0.90]; p = .0001; Figure 3). Also, some studies 9,13 found that the complication of AKI was significantly lower in the IH cohort as compared with the OOH cohort (n = 120 [27%] vs. n = 144…”

“…A sensitivity analysis was done by removing studies with a large cohort size (n > 1000) from the data analysis to determine whether these studies had biased our reported outcomes. When the sensitivity analysis was carried out, the 30-day mortality was found not to be significantly different between the OOH and IH cohorts (n = 180 Figure S11) despite each individual study [8][9][10][11][12][13] reporting lower 30-day mortality rates in the IH cohort as compared with the OOH cohort. This sensitivity analysis demonstrates that there is a potential bias in the reported 30-day mortality rate due to greater weightage given to studies with larger sample sizes in the metaanalysis, thus skewing the accuracy of its results.…”

“…Full text of the remaining 45 papers was screened, yielding six studies to be included in the systematic review and meta-analysis. [8][9][10][11][12][13] The PRISMA flow chart illustrates these search results in Figure S1. The characteristics of the included studies are summarized in Table 1.…”