Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand.
Anatomy with Medical Imaging FMHS, University of Auckland, Auckland, New Zealand.
J Card Surg. 2021 Jun;36(6):2035-2043. doi: 10.1111/jocs.15457. Epub 2021 Mar 8.
Socioeconomic deprivation (SED) has been associated with increased 30-day mortality and reduced long-term survival after surgical repair of acute type A aortic dissection (ATAAD). The study aimed to determine the incidence rate ratio of ATAAD in New Zealand population with higher and lower SED indices and to evaluate any association between SED and outcomes after ATAAD repair.
This was a retrospective cohort study. Patients who underwent ATAAD repair from March 2003 to May 2020 were identified. Overseas patients, those with chronic aortic dissection, and those who died in hospital before the operation were excluded. The total number of New Zealand residents was estimated based on the national 2018 Census.
A total of 363 ATAAD patients met the eligibility criteria. The incidence of ATAAD was 70% greater in those who were more socioeconomically deprived (higher SED) compared with less socioeconomically deprived (lower SED) New Zealanders (odds ratio = 1.7; 95% confidence interval [CI] = 1.4-2.1; p < .0005). Postoperative cardiogenic shock, renal failure, pulmonary embolism, and respiratory failure were more common in the higher than in the lower SED group. Both groups had similar operative and in-hospital mortality and time intervals in the intensive care unit and hospital. Both groups had similar freedom from reoperation (hazards ratio [HR] = 1.1; 95% CI = 0.5-2.6; p = .746) and long-term survival (HR = 0.73; 95% CI = 0.5-1.1; p = .115).
The incidence of ATAAD is greater in more socioeconomically deprived New Zealand residents. Following ATAAD repair, SED is not associated with worse short- or long-term outcomes in the universal health care system.
社会经济剥夺（SED）与急性 A 型主动脉夹层（ATAAD）手术后 30 天死亡率增加和长期生存率降低有关。本研究旨在确定新西兰社会经济剥夺程度较高和较低的人群中 ATAAD 的发病率比值，并评估 SED 与 ATAAD 修复后结果之间的任何关联。
这是一项回顾性队列研究。确定了 2003 年 3 月至 2020 年 5 月期间接受 ATAAD 修复的患者。排除了海外患者、慢性主动脉夹层患者以及手术前在医院死亡的患者。根据 2018 年全国人口普查，估计了新西兰居民的总数。
共有 363 名 ATAAD 患者符合入选标准。与社会经济剥夺程度较低（SED）的新西兰人相比，社会经济剥夺程度较高（SED）的患者 ATAAD 的发病率高 70%（优势比[OR] = 1.7；95%置信区间[CI] = 1.4-2.1；p < 0.0005）。术后心源性休克、肾衰竭、肺栓塞和呼吸衰竭在 SED 较高组中更为常见。SED 较高组和较低组的手术和住院死亡率以及在重症监护病房和医院的时间间隔均相似。两组的再次手术（风险比[HR] = 1.1；95% CI = 0.5-2.6；p = 0.746）和长期生存率（HR = 0.73；95% CI = 0.5-1.1；p = 0.115）相似。
在社会经济剥夺程度较高的新西兰居民中，ATAAD 的发病率更高。在全民健康保障体系中，ATAAD 修复后，SED 与短期或长期预后不良无关。
