Diaz-Castrillon Carlos E, Serna-Gallegos Derek, Arnaoutakis George, Szeto Wilson Y, Pompeu Sá Michel, Sezer Ahmet, Sultan Ibrahim
Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin, Austin, Tex.
J Thorac Cardiovasc Surg. 2025 May;169(5):1415-1426.e11. doi: 10.1016/j.jtcvs.2024.07.015. Epub 2024 Jul 14.
The relationship between the number and type of postoperative complications and mortality in the setting for surgery for acute type A aortic dissection (ATAAD) remains underexplored despite its critical role in the failure-to-rescue (FTR) metric.
This retrospective study used data from the Society of Thoracic Surgeons Adult Cardiac Surgical Database on ATAAD surgeries performed between January 2018 and December 2022. Patients were categorized based on their number of major complications. The primary outcome was FTR. We used multilevel regression and classification and regression tree models.
We included 19,243 patients (33% females), with a median age of 61 years. Regarding complications, 47.7% of patients had 0, 20.2% had 1, 12.7% had 2, and 19.4% experienced 3 or more. The most frequently reported complications were prolonged mechanical ventilation (30.3%), unplanned reoperation (19.5%), and renal failure (17.2%). Cardiac arrest occurred in 7.1% of cases. FTR increased from 13% in patients with 1 complication to >30% in those with 4 or more complications. Cardiac arrest (adjusted odds ratio [aOR], 10.9) and renal failure (aOR, 5.3) had the highest odds for mortality, followed by limb ischemia (aOR, 2.7), stroke (aOR, 2.6), and gastrointestinal complications (aOR, 2.4). Hospitals in the top performance quartile consistently showed lower FTR rates across all levels of complication.
The study validates a dose-response association between postoperative complications and mortality in patients undergoing surgery for ATAAD. Top-performing hospitals consistently show lower FTR rates independent of the number of complications. Future research should focus on the timing of complications and interventions to reduce the burden of complications.
尽管术后并发症的数量和类型与急性A型主动脉夹层（ATAAD）手术死亡率之间的关系在未能成功救治（FTR）指标中起着关键作用，但仍未得到充分研究。
这项回顾性研究使用了来自胸外科医师协会成人心脏手术数据库的数据，这些数据来自2018年1月至2022年12月期间进行的ATAAD手术。患者根据其主要并发症的数量进行分类。主要结局是FTR。我们使用了多水平回归以及分类和回归树模型。
我们纳入了19243例患者（33%为女性），中位年龄为61岁。关于并发症，47.7%的患者无并发症，20.2%的患者有1种并发症，12.7%的患者有2种并发症，19.4%的患者有3种或更多并发症。最常报告的并发症是机械通气时间延长（30.3%）、计划外再次手术（19.5%）和肾衰竭（17.2%）。7.1%的病例发生心脏骤停。FTR从有1种并发症的患者中的13%增加到有4种或更多并发症的患者中的>30%。心脏骤停（调整优势比[aOR]，10.9）和肾衰竭（aOR，5.3）的死亡几率最高，其次是肢体缺血（aOR，2.7）、中风（aOR，2.6）和胃肠道并发症（aOR，2.4）。表现最佳的四分位医院在所有并发症水平上始终显示出较低的FTR率。
该研究证实了接受ATAAD手术患者术后并发症与死亡率之间的剂量反应关联。表现最佳的医院始终显示出较低的FTR率，与并发症数量无关。未来的研究应关注并发症的发生时间和干预措施，以减轻并发症的负担。
