Nighttime Surgery for Acute Aortic Dissection Type A—A 18-Year Single-Center Experience

Objectives: Recent literature highlighted worse outcome of patients undergoing nighttime surgery for Type A aortic dissection (AADA). The objectives of our study were to evaluate whether surgery during nighttime has a negative impact on mortality and postoperative morbidity and if patients in a stable preoperative condition benefit from an elective daytime setting.

Methods: Our hospital database for was screened for time of skin incision for repair of AADA. Mortality and morbidity were compared between nighttime (time of skin incision 19:00–5:00) and daytime (time of skin incision 05:01–18:59) surgery. Liberal surgical approach with a short time interval from symptom onset to surgery is pursued at our institution for all patients with AADA, regardless patient’s preoperative state. Baseline and operative data did not differ between the two groups except for a higher rate of axillary arterial cannulation site in the daytime group (p = 0.027). Preoperative risk factors, operative data, as well as outcome parameters were evaluated for 30-day mortality.

Results: From May 2000 to March 2018, 345 patients underwent surgery for AADA. Time of skin incision was available in 92% (n = 319). 46.7% (n = 149) of all patients were already suffering from a complication of the underlying AADA and presented in a critical preoperative state. Overall 30-day mortality was 15.6% (n = 51). Surgery during nighttime was performed in 41% (n = 131) of our study cohort. Multivariate analysis excluded nighttime surgery to be an independent risk factor for 30-day mortality, but identified age (OR 1.043, 95% CI 1.015–1.071, p = 0.002), pericardial tamponade (OR 2.491, 95% CI 1.177–5.271, p = 0.017), malperfusion syndrome (OR 2.524, 95% CI 1.210–5.266, p = 0.014), and intubation (OR 4.072, 95% CI 1.275–13.003, p = 0.018) as independent preoperative risk factors. There was no significant difference in survival and morbidity between nighttime and daytime groups.

Conclusion: We could not confirm recent finding of worse outcome in patients undergoing surgery during nighttime.

	All patients (n = 319)	Nighttime (n = 129)	Daytime (n = 190)	p-Value
Note: Comparison of operative and outcome data between nighttime and daytime groups.
ECC time (median, min)	220	228.5	218	0.389
Selective antegrade cerebral perfusion	214 (67%)	81 (63%)	133 (70%)	0.389
Postoperative malperfusion syndrome	49 (15%)	18 (14%)	31 (16%)	0.725
Postoperative neurologic injury	54 (17%)	22 (17%)	32 (17%)	0.961
Need for postoperative hemofiltration	97 (30%)	44 (34%)	53 (28%)	0.194
Revision for bleeding	81 (25%)	32 (25%)	49 (26%)	0.938
30-d mortality	51 (16%)	21 (16%)	30 (16%)	0.923