TY - JOUR
T1 - Association between prehospital transfer distance and surgical mortality in emergency thoracic aortic surgery
AU - Izumisawa, Yu
AU - Endo, Hideki
AU - Ichihara, Nao
AU - Takahashi, Arata
AU - Nawata, Kan
AU - Shiraishi, Hiroshi
AU - Miyata, Hiroaki
AU - Motomura, Noboru
N1 - Funding Information:
Y. Izumisawa, H. Shiraishi, and H. Miyata received funding from the Japan Science and Technology Agency (Research Complex Program “Wellbeing Research Campus: Creating new values through technological and social innovation”). The funding body did not have any role in the design and conduct of the study, data collection, data analysis, data management, data interpretation, or the preparation, review, and approval of this manuscript.H. Endo, N. Ichihara, A. Takahashi, K. Nawata, and H. Miyata are affiliated with the Department of Healthcare Quality Assessment, which is a social collaboration department at the University of Tokyo supported by the National Clinical Database, Johnson & Johnson K.K., and Nipro Corporation. None of the entities had any role in the design and conduct of the study, data collection, data analysis, data management, data interpretation, or the preparation, review, and approval of this manuscript. All other authors have nothing to disclose with regard to commercial support.We thank the Japan Science and Technology Agency for funding this study. We also thank Shinichi Takamoto for supporting this study and all participating hospitals in the Japan Cardiovascular Surgery Database for their efforts in collecting and submitting data.
Funding Information:
Y. Izumisawa, H. Shiraishi, and H. Miyata received funding from the Japan Science and Technology Agency (Research Complex Program “Wellbeing Research Campus: Creating new values through technological and social innovation”). The funding body did not have any role in the design and conduct of the study, data collection, data analysis, data management, data interpretation, or the preparation, review, and approval of this manuscript.
Publisher Copyright:
© 2020 The American Association for Thoracic Surgery
PY - 2022/1
Y1 - 2022/1
N2 - Objective: To examine whether there is an association between prehospital transfer distance and surgical mortality in emergency thoracic aortic surgery. Methods: A retrospective cohort study using a national clinical database in Japan was conducted. Patients who underwent emergency thoracic aortic surgery from January 1, 2014, to December 31, 2016, were included. Patients with type B dissection were excluded. A multilevel logistic regression analysis was performed to examine the association between prehospital transfer distance and surgical mortality. In addition, an instrumental variable analysis was performed to address unmeasured confounding. Results: A total of 12,004 patients underwent emergency thoracic aortic surgeries at 495 hospitals. Surgical mortality was 13.8%. The risk-adjusted mortality odds ratio for standardized distance (mean 12.8 km, standard deviation 15.2 km) was 0.94 (95% confidence interval, 0.87-1.01; P = .09). Instrumental variable analysis did not reveal a significant association between transfer distance and surgical mortality as well. Conclusions: No significant association was found between surgical mortality and prehospital transfer distance in emergency thoracic aortic surgery cases. Suspected cases of acute thoracic aortic syndrome may be transferred safely to distant high-volume hospitals.
AB - Objective: To examine whether there is an association between prehospital transfer distance and surgical mortality in emergency thoracic aortic surgery. Methods: A retrospective cohort study using a national clinical database in Japan was conducted. Patients who underwent emergency thoracic aortic surgery from January 1, 2014, to December 31, 2016, were included. Patients with type B dissection were excluded. A multilevel logistic regression analysis was performed to examine the association between prehospital transfer distance and surgical mortality. In addition, an instrumental variable analysis was performed to address unmeasured confounding. Results: A total of 12,004 patients underwent emergency thoracic aortic surgeries at 495 hospitals. Surgical mortality was 13.8%. The risk-adjusted mortality odds ratio for standardized distance (mean 12.8 km, standard deviation 15.2 km) was 0.94 (95% confidence interval, 0.87-1.01; P = .09). Instrumental variable analysis did not reveal a significant association between transfer distance and surgical mortality as well. Conclusions: No significant association was found between surgical mortality and prehospital transfer distance in emergency thoracic aortic surgery cases. Suspected cases of acute thoracic aortic syndrome may be transferred safely to distant high-volume hospitals.
KW - emergency medical service
KW - emergency surgery
KW - prehospital
KW - surgical mortality
KW - thoracic aortic surgery
KW - transfer distance
UR - http://www.scopus.com/inward/record.url?scp=85083493186&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85083493186&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2020.03.043
DO - 10.1016/j.jtcvs.2020.03.043
M3 - Article
C2 - 32331819
AN - SCOPUS:85083493186
SN - 0022-5223
VL - 163
SP - 28-35.e1
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 1
ER -