Impact of Direct or Indirect Transfer on Acute Type A Aortic Dissection in The Tokai Region of Japan
Abstract
Kayo Sugiyama, Hirotaka Watanuki, Masato Tochii1, Yuji Kuge, Daisuke Koiwa, Katsuhiko Matsuyama
Objectives: To evaluate the outcomes of direct versus indirect transfer in treating acute type A aortic dissection (ATAAD) and assess the outcomes of patients transferred from tertiary versus non-tertiary hospitals.
Materials and MethodsThis study included 98 patients with ATAAD who underwent emergency surgery at our hospital from August 2015 to July 2023. We compared patients transferred directly to our hospital for emergency surgery with those transferred to other hospitals before ours.
Results Patients transferred from other hospitals had a significantly longer time from disease onset to arrival at the hospital and arrival in the operating room. However, they had a good preoperative condition, shorter postoperative hospital stay, lower major adverse cardiac or cerebrovascular events, and lower late mortality. Preoperative patient pathology or postoperative course among them showed no significant differences, regardless of whether the patient was transferred from a non-tertiary hospital.
Conclusions Patients transferred from other hospitals had better outcomes, most likely because they were relatively low-risk; high-risk cases might not have been efficiently transferred. The size of the referring hospital was not associated with the prognosis. Developing a network system in the Tokai region to efficiently transfer high-risk patients with acute aortic syndrome is warranted.