Association of interhospital transfer with postoperative outcomes of repair for type A aortic dissection.

Abstract

Despite advancements in risk stratification and surgical management, acute type A aortic dissection (TAAD) carries high early mortality and requires emergent surgical repair. While regionalization of care to high-volume centers has demonstrated superior outcomes, interfacility transfer introduces treatment delays and risk of patient deterioration during transport. Using a nationally representative cohort, we sought to characterize the independent association between transfer status and clinical outcomes following TAAD repair. Adult patients (≥18 years) undergoing emergency TAAD repair were tabulated from the 2017-2022 Nationwide Readmissions Database. Patients were stratified based on transfer status. Entropy balancing was used to adjust for baseline differences between cohorts, and multivariable regression models assessed the association of transfer status with mortality, perioperative complications, length of stay, and hospitalization costs. Of 27,043 patients, 2,131 (7.9%) were transferred. Following doubly robust risk-adjustment, transferred patients had reduced in-hospital mortality (Adjusted Odds Ratio [AOR] 0.77, 95% Confidence Interval [CI] 0.63-0.94), yet increased odds of cardiac (AOR 1.45, 95% CI 1.26-1.67) and infectious complications (AOR 1.57, 95% CI 1.34-1.84). Additionally, transfer patients incurred greater hospitalization costs (β+ $19,740, 95% CI 12,630-26,860) and greater lengths of stay (β + 5.36 days, CI 4.06-6.66). Interfacility transfer for TAAD repair was associated with increased complications, longer hospitalizations, and greater resource utilization, though reduced in-hospital mortality. These findings highlight the importance of regionalized aortic care and the need for standardized transfer protocols to optimize outcomes in this high-risk population.