Sociodemographic Determinants of Hospital Admission and Follow-Up in Aortic Dissection: A Two-Center Retrospective Cohort Study.

BACKGROUND

Ascending and descending aortic dissection (AD) carry significant morbidity and mortality and require regular follow-up in surgery. The aim of this retrospective analysis is to compare the demographics and comorbidities of patients with AD who followed up in clinic to those who did not. The goal of this study is to identify barriers to follow-up in AD to better mitigate complications in vulnerable populations.

METHODS

The electronic medical record was reviewed for all acute presentations of AD in patients 18 or older during the period of January 2015 through May 2023. Records were reviewed for demographic descriptors, comorbidities, hospital courses, and follow-up with vascular or cardiothoracic surgery. Univariate and multivariate regression analyses were conducted to compare follow-up and nonfollow-up cohorts across the entire sample and in ascending and descending groups separately.

RESULTS

A total of 122 patients with AD were identified and included. Patients who followed up were younger (P < 0.001) and had higher body mass index (P < 0.05). A significantly higher number of patients on public insurance were followed up compared to patients with private or union-based insurance (P < 0.05). Patients who underwent surgery on index admission also skewed more heavily into the follow-up cohort (P < 0.05). In the ascending group (n = 68) analysis, patients who followed up in clinic were younger (P < 0.001) and had longer hospital and intensive care unit length of stay (P < 0.01). In the descending group (n = 54), patients with a history of substance abuse skewed significantly into the nonfollow-up cohort (P < 0.05).

CONCLUSION

Age strongly determined follow-up in the overall and type A group analyses. Insurance status was a significant factor in the whole sample analysis, whereas hospital and intensive care unit length of stay significantly impacted the type A subgroup. In the descending group, patients with a history of substance abuse showed reduced follow-up. Further studies are required to evaluate these findings at other centers.