Hambright Benjamin, Williams Lamario, Xie Rongbing, Still Sasha A
Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Ala.
Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala.
JTCVS Open. 2025 Jan 31;24:332-340. doi: 10.1016/j.xjon.2025.01.013. eCollection 2025 Apr.
Type A aortic dissection repair is an emergency operation associated with both higher perioperative and postoperative risk. This study investigates the influence of socioeconomic status, as measured by the Distressed Communities Index (DCI), on patients who underwent acute aortic dissection repair and their postoperative outcomes.
We conducted a retrospective analysis of 240 adult patients who underwent repair for acute Stanford Type A aortic dissection from 2009 to 2021. Patients were categorized into an at-risk group (DCI score ≥75) and a not-at-risk group (DCI score <75) based on their zip code. We collected demographic, clinical, operative, and postoperative outcomes, analyzing data using descriptive statistics and multivariable logistic regression. Kaplan-Meier survival analysis assessed 5-year survival outcomes.
At-risk patients were significantly younger (52 vs 59 years; = .03) and more commonly African American (59.02% vs 26.5%; < .0001). Although chronic health condition rates were similar, at-risk patients showed trends toward higher rates of postoperative respiratory failure (27.1% vs 18.0%; = .0926) and longer hospital stays (27.05% vs 15.25% for length of stay of 8-13 days; = .065). However, rates of postoperative complications, including 30-day mortality and 5-year survival, were not significantly different between groups, and at-risk status did not significantly predict mortality (hazard ratio, 1.35; 95% CI, 0.65-2.79; = .43).
Patients undergoing urgent surgery for acute Type A aortic dissection have similar postoperative outcomes, although at-risk patients may experience longer hospital stays and higher respiratory failure rates. Further study is necessary to understand the effect of DCI score on intermediate and long-term outcomes to mitigate social disparities and diminish modifiable risk factors.
A型主动脉夹层修复术是一种急诊手术，围手术期和术后风险均较高。本研究调查了以困境社区指数（DCI）衡量的社会经济地位对接受急性主动脉夹层修复术患者及其术后结局的影响。
我们对2009年至2021年接受急性斯坦福A型主动脉夹层修复术的240例成年患者进行了回顾性分析。根据患者的邮政编码，将其分为高危组（DCI评分≥75）和非高危组（DCI评分<75）。我们收集了人口统计学、临床、手术和术后结局数据，使用描述性统计和多变量逻辑回归分析数据。Kaplan-Meier生存分析评估了5年生存结局。
高危患者明显更年轻（52岁对59岁；P = 0.03），非裔美国人更为常见（59.02%对26.5%；P < 0.0001）。尽管慢性健康状况发生率相似，但高危患者术后呼吸衰竭发生率有升高趋势（27.1%对18.0%；P = 0.0926），住院时间更长（住院8 - 13天的比例为27.05%对15.25%；P = 0.065）。然而，两组术后并发症发生率，包括30天死亡率和5年生存率，差异无统计学意义，高危状态并不能显著预测死亡率（风险比，1.35；95%置信区间，0.65 - 2.79；P = 0.43）。
接受急性A型主动脉夹层紧急手术的患者术后结局相似，尽管高危患者可能住院时间更长，呼吸衰竭发生率更高。有必要进一步研究以了解DCI评分对中期和长期结局的影响，以减轻社会差异并减少可改变的风险因素。
