• Christopher K Mehta, Stephen Chiu, Andrew W Hoel, Patricia Vassallo, Beth Whippo, Adin Cristian Andrei, Michael J Schmidt, PhamDuc ThinhDTDivision of Cardiac Surgery, Northwestern Feinberg School of Medicine and Northwestern Medicine, Chicago, IL, USA., Douglas R Johnston, Andrei Churyla, and S Chris Malaisrie.
• Division of Cardiac Surgery, Northwestern Feinberg School of Medicine and Northwestern Medicine, Chicago, IL, USA. Electronic address: christopher.mehta@nm.org.
• Am J Emerg Med. 2023 Aug 1; 70: 113118113-118.

IntroductionType A Aortic Dissection (TAAD) is a surgical emergency with a time-dependent rate of mortality. We hypothesized that a direct-to-operating room (DOR) transfer program for patients with TAAD would reduce time to intervention.MethodsA DOR program was started at an urban tertiary care hospital in February 2020. We performed a retrospective study of adult patients undergoing treatment for TAAD before (n = 42) and after (n = 84) implementation of DOR. Expected mortality was calculated using the International Registry of Acute Aortic Dissection risk prediction model.ResultsMedian time from acceptance of transfer from emergency physician to operating room arrival was 1.37 h (82 min) faster in DOR compared to pre-DOR (1.93 h vs 3.30 h, p < 0.001). Median time from arrival to operating room was 1.14 h (72 min) faster after DOR compared to pre-DOR (0.17 h vs 1.31 h, p < 0.001). In-hospital mortality was 16.2% in pre-DOR, with an observed-to-expected (O/E) ratio of 1.03 (p = 0.24) and 12.0% in the DOR group, with an O/E ratio of 0.59 (p < 0.001).ConclusionCreation of a DOR program resulted in decreased time to intervention. This was associated with a decrease in observed-to-expected operative mortality. The transfer of patients with acute type A aortic dissection to centers with direct-to-OR programs may result in decreased time from diagnosis to surgery.Copyright © 2023 Elsevier Inc. All rights reserved.

13 keywords...

hide…