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Cited by 11Aortic Disease and Treatment ApproachesAortic aneurysm repair treatmentsConnective tissue disorders research

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The burden of major complications on failure to rescue after surgery for acute type A aortic dissection: Analysis of more than 19,000 patients

Diaz-Castrillon, Carlos E., Serna-Gallegos, Derek, Arnaoutakis, George, Szeto, Wilson Y., Pompeu Sá, Michel, Sezer, Ahmet, Sultan, Ibrahim·2025·The Journal of Thoracic and Cardiovascular Surgery
DOI 10.1016/j.jtcvs.2024.07.015
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Abstract

Background 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. Methods 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. Results 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. Conclusions 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.

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References 30 · Cited by 11

Research works printed but not linked: 30

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Metadata

Authors
Diaz-Castrillon, C. E., Serna-Gallegos, D., Arnaoutakis, G., Szeto, W. Y., Pompeu Sá, M., Sezer, A., & Sultan, I.
Affiliations
  • University of Pittsburgh (US)
  • The University of Texas at Austin (US)
  • University of Pennsylvania (US)
Corresponding author
Sultan, Ibrahim
ORCID
Venue
The Journal of Thoracic and Cardiovascular Surgery
Publisher
Elsevier BV
Published
2025-05
Volume
169
Issue
5
Pages
1415-1426.e11
ISSN
0022-5223 (ISSN-L)
DOI
10.1016/j.jtcvs.2024.07.015
OpenAlex
W4400617486
Cited by
11
References
30
Citations by year
2026: 4 · 2025: 7
FWCI
3.19
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
  • PubMed (publishedVersion)
Funders
Society of Thoracic Surgeons
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Aortic Disease and Treatment Approaches
  • Health Sciences › Medicine › Surgery › Aortic aneurysm repair treatments
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Connective tissue disorders research
Keywords
acute type A aortic dissection, failure to rescue, postoperative complications, postoperative mortality, cardiac arrest, renal failure, prolonged mechanical ventilation, unplanned reoperation, hospital performance, dose-response relationship
MeSH terms
Failure to Rescue, Health Care, Acute Disease, Aged, Aortic Dissection, Aortic Aneurysm, Female, Humans, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Risk Factors, Time Factors, Vascular Surgical Procedures, Databases, Factual, Risk Assessment

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