• Fausto Biancari, Amelié Hérve, Sven Peterss, Caroline Radner, Joscha Buech, Matteo Pettinari, Rodriguez LegaJavierJDepartment of Cardiovascular Surgery, University Hospital Gregorio Marañón, Madrid, Spain., Angel G Pinto, Antonio Fiore, Francesco Onorati, Alessandra Francica, Konrad Wisniewski, Till Demal, Lenard Conradi, Jan Rocek, Petr Kacer, Giuseppe Gatti, Igor Vendramin, Mauro Rinaldi, Luisa Ferrante, Robert Pruna-Guillen, Eduard Quintana, Dario DI Perna, Giovanni Mariscalco, Mikko Jormalainen, Mark Field, Amer Harky, Angelo M Dell'aquila, Tatu Juvonen, Timo Mäkikallio, and Andrea Perrotti.
• Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland - faustobiancari@yahoo.it.
• Minerva Anestesiol. 2024 Jul 1; 90 (7-8): 654661654-661.

BackgroundThe outcomes after prolonged treatment in the intensive care unit (ICU) after surgery for Stanford type A aortic dissection (TAAD) have not been previously investigated.MethodsThis analysis included 3538 patients from a multicenter study who underwent surgery for acute TAAD and were admitted to the cardiac surgical ICU.ResultsThe mean length of stay in the cardiac surgical ICU was 9.9±9.5 days. The mean overall costs of treatment in the cardiac surgical ICU 24086±32084 €. In-hospital mortality was 14.8% and 5-year mortality was 30.5%. Adjusted analyses showed that prolonged ICU stay was associated with significantly lower risk of in-hospital mortality (adjusted OR 0.971, 95%CI 0.959-0.982), and of five-year mortality (adjusted OR 0.970, 95%CI 0.962-0.977), respectively. Propensity score matching analysis yielded 870 pairs of patients with short ICU stay (2-5 days) and long ICU stay (>5 days) with balanced baseline, operative and postoperative variables. Patients with prolonged ICU stay (>5 days) had significantly lower in-hospital mortality (8.9% vs. 17.4%, <0.001) and 5-year mortality (28.2% vs. 30.7%, P=0.007) compared to patients with short ICU-stay (2-5 days).ConclusionsProlonged ICU stay was common after surgery for acute TAAD. However, when adjusted for multiple baseline and operative variables as well as adverse postoperative events and the cluster effect of hospitals, it was associated with favorable survival up to 5 years after surgery.

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