背景:A型主动脉夹层(TAAD)是一种需要立即干预的紧急情况。外周动脉疾病(PAD)是一种在各种心血管手术中与不良预后相关的普遍疾病。然而,目前尚不清楚PAD是否会影响TAAD修复的结局.本研究旨在进行基于人群的分析,以评估PAD对TAAD修复后住院结局的影响。
方法:在2015年第四季度至2020年的全国住院患者样本中确定了接受TAAD修复的患者。多变量逻辑回归用于比较有和无PAD患者的院内预后。根据人口统计进行调整,社会经济地位,主要付款人身份,医院特色,合并症,和转学/入学状态。
结果:1525例PAD患者和2757例非PAD患者接受TAAD。PAD患者死亡率较高(18.62%vs13.17%,OR=1.287,p=.01),AKI(51.41%vs47.48%,OR=1.222,p<.01),感染(10.69%vs8.02%,OR=1.269,p=.03),血管并发症(7.28%vs3.77%,aOR=1.846,p<.01),但心包并发症的风险较低(15.21%vs19.95%,OR=0.696,p<.01)。此外,PAD患者从入院到手术的时间更长(1.29±3.95vs0.70±2.09天,p<.01),LOS更长(14.92±13.98vs13.41±11.66天,p=.01),和更高的医院费用(499,064±519,405对409,754±405,663美元,p<.01)。
结论:PAD与TAAD修复后不良预后独立相关。死亡率上升可能归因于手术延误,这可能与PAD患者常见的术前外周灌注不良综合征有关。术前管理和立即TAAD修复之间的平衡可能对于防止PAD患者因治疗延迟而增加的死亡风险至关重要。
BACKGROUND: Type A aortic dissection (TAAD) is an emergent condition that warrants immediate intervention. Peripheral artery disease (PAD) is a prevalent disease associated with worse outcomes in various cardiovascular procedures. However, it remains unclear whether PAD influences outcomes of TAAD repair. This study aimed to undertake a population-based analysis to assess impact of PAD on in-hospital outcomes following TAAD repair.
METHODS: Patients underwent TAAD repair were identified in National Inpatient Sample from Q4 2015 to 2020. Multivariable logistic regressions were used to compare in-hospital outcomes between patients with and without PAD, adjusted for demographics, socioeconomic status, primary payer status, hospital characteristics, comorbidities, and transfer/admission status.
RESULTS: 1525 patients with PAD and 2757 non-PAD patients underwent TAAD. PAD patients had higher mortality (18.62% vs 13.17%, aOR = 1.287, p = .01), AKI (51.41% vs 47.48%, aOR = 1.222, p < .01), infection (10.69% vs 8.02%, aOR = 1.269, p = .03), and vascular complication (7.28% vs 3.77%, aOR = 1.846, p < .01) but lower risks of pericardial complications (15.21% vs 19.95%, aOR = 0.696, p < .01). In addition, patients with PAD had longer time from admission to operation (1.29 ± 3.95 vs 0.70 ± 2.09 days, p < .01), longer LOS (14.92 ± 13.98 vs 13.41 ± 11.66 days, p = .01), and higher hospital charge (499,064 ± 519,405 vs 409,754 ± 405,663 US dollars, p < .01).
CONCLUSIONS: PAD was independently associated with worse outcome after TAAD repair. The elevated mortality rate could be attributed to the
delay in surgery, which may be related to preoperative peripheral malperfusion syndrome that is common in PAD patients. A balance between preoperative management and immediate TAAD repair might be essential to prevent the increased mortality risk from treatment delays among PAD patients.