• Br J Surg · Aug 2023

    Acute aortic syndrome: nationwide study of epidemiology, management, and outcomes.

    • William Xu, Cheyaanthan Haran, Anastasia Dean, Eric Lim, Oliver Bernau, Kevin Mani, Adib Khanafer, Suzanne Pitama, and Manar Khashram.
    • Department of Surgery, University of Auckland, Auckland, New Zealand.
    • Br J Surg. 2023 Aug 11; 110 (9): 119712051197-1205.

    BackgroundEpidemiological studies on acute aortic syndrome (AAS) have relied largely on unverified administrative coding, leading to wide-ranging estimates of incidence. This study aimed to evaluate the incidence, management, and outcomes of AAS in Aotearoa New Zealand.MethodsThis was a national population-based retrospective study of patients presenting with an index admission of AAS from 2010 to 2020. Cases from the Ministry of Health National Minimum Dataset, National Mortality Collection, and the Australasian Vascular Audit were cross-verified with hospital notes. Poisson regression adjusted for sex and age was used to investigate trends over time.ResultsDuring the study interval, 1295 patients presented to hospital with confirmed AAS, including 790 with type A (61.0 per cent) and 505 with type B (39.0 per cent) AAS. A total of 290 patients died out of hospital between 2010 and 2018. The overall incidence of aortic dissection including out-of-hospital cases was 3.13 (95 per cent c.i. 2.96 to 3.30) per 100 000 person-years, and this increased by an average of 3 (95 per cent c.i. 1 to 6) per cent per year after adjustment for age and sex adjustment on Poisson regression, driven by increasing type A cases. Age-standardized rates of disease were higher in men, and in Māori and Pacific populations. The management strategies used, and 30-day mortality rates among patients with type A (31.9 per cent) and B (9.7 per cent) disease have remained constant over time.ConclusionMortality after AAS remains high despite advances over the past decade. The disease incidence and burden are likely to continue to increase with an ageing population. There is impetus now for further work on disease prevention and the reduction of ethnic disparities.© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.

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