Surgery · 2026
Association of interhospital transfer with postoperative outcomes of repair for type A aortic dissection.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Rahmani Jaden, Ali Konmal, Lai Owen, Mehta Deep, Ali Syed Shaheer, Sanaiha Yas, Benharash Peyman
Аннотация
INTRODUCTION: Despite advancements in risk stratification and surgical management, acute type A aortic dissection (TAAD) carries high early mortality and requires emergent surgical repair. While regionalization of care to high-volume centers has demonstrated superior outcomes, interfacility transfer introduces treatment delays and risk of patient deterioration during transport. Using a nationally representative cohort, we sought to characterize the independent association between transfer status and clinical outcomes following TAAD repair.
METHODS: Adult patients (≥18 years) undergoing emergency TAAD repair were tabulated from the 2017-2022 Nationwide Readmissions Database. Patients were stratified based on transfer status. Entropy balancing was used to adjust for baseline differences between cohorts, and multivariable regression models assessed the association of transfer status with mortality, perioperative complications, length of stay, and hospitalization costs.
RESULTS: Of 27,043 patients, 2,131 (7.9%) were transferred. Following doubly robust risk-adjustment, transferred patients had reduced in-hospital mortality (Adjusted Odds Ratio [AOR] 0.77, 95% Confidence Interval [CI] 0.63-0.94), yet increased odds of cardiac (AOR 1.45, 95% CI 1.26-1.67) and infectious complications (AOR 1.57, 95% CI 1.34-1.84). Additionally, transfer patients incurred greater hospitalization costs (β+ $19,740, 95% CI 12,630-26,860) and greater lengths of stay (β + 5.36 days, CI 4.06-6.66).
CONCLUSION: Interfacility transfer for TAAD repair was associated with increased complications, longer hospitalizations, and greater resource utilization, though reduced in-hospital mortality. These findings highlight the importance of regionalized aortic care and the need for standardized transfer protocols to optimize outcomes in this high-risk population.
METHODS: Adult patients (≥18 years) undergoing emergency TAAD repair were tabulated from the 2017-2022 Nationwide Readmissions Database. Patients were stratified based on transfer status. Entropy balancing was used to adjust for baseline differences between cohorts, and multivariable regression models assessed the association of transfer status with mortality, perioperative complications, length of stay, and hospitalization costs.
RESULTS: Of 27,043 patients, 2,131 (7.9%) were transferred. Following doubly robust risk-adjustment, transferred patients had reduced in-hospital mortality (Adjusted Odds Ratio [AOR] 0.77, 95% Confidence Interval [CI] 0.63-0.94), yet increased odds of cardiac (AOR 1.45, 95% CI 1.26-1.67) and infectious complications (AOR 1.57, 95% CI 1.34-1.84). Additionally, transfer patients incurred greater hospitalization costs (β+ $19,740, 95% CI 12,630-26,860) and greater lengths of stay (β + 5.36 days, CI 4.06-6.66).
CONCLUSION: Interfacility transfer for TAAD repair was associated with increased complications, longer hospitalizations, and greater resource utilization, though reduced in-hospital mortality. These findings highlight the importance of regionalized aortic care and the need for standardized transfer protocols to optimize outcomes in this high-risk population.