Aortic Dissections in the Elderly: Older Age in Patients With Acute Aortic Syndromes Is Associated With Delayed Time to Surgery.

Objective: In the setting of acute aortic syndromes, timely access to definitive surgical repair is of paramount importance. Older patients, primarily septuagenarians and octogenarians, undergoing emergent ascending arch repair experience higher rates of mortality compared to younger patients. Despite this risk, studies show that surgical management is still superior to medical management for this patient population. The objective of this study is to determine if older age impacts the time from presentation to the start of surgery for patients with acute aortic syndromes undergoing surgical repair.

Methods: This retrospective review included all patients with acute aortic syndromes who underwent emergent ascending aortic arch repair from January 2018 to May 2023 at a single academic institution. Our analysis compared outcomes for older patients (age 70 years and older) with younger patients (age less than 70 years). Primary outcomes included 30-day mortality, postoperative stay, time from emergency department presentation to the start of surgery, and time from diagnosis with computed tomography to the start of surgery. Secondary outcomes included postoperative complications. Outcomes were analyzed using chi-squared and Student's t-tests, with significance set at p<0.05.

Results: Of 107 patients included (male, N=57), 71 (66%) were under the age of 70 and 36 (34%) were 70 years of age or older. The younger cohort had more male and non-White patients, with no differences in rates of hypertension, dyslipidemia, and smoking history. With no difference in the rate of transfers from outside hospitals, we observed longer times from presentation to the start of surgery for older patients compared to younger patients (7 hours and 13 minutes vs. 6 hours 25 minutes; p=0.02) and also for time of diagnosis to the start of surgery (4 hours 22 minutes vs. 3 hours 54 minutes; p=0.006). Older patients had higher rates of intraoperative (0% vs. 17%, p<0.001) and 30-day (7% vs. 44%, p<0.001) mortality. There were no differences in length of stay or in rates of postoperative complications and surgery-related emergency department visits.

Conclusions: Patients aged 70 and older experienced delays from the time of presentation to the start of surgery and from time of diagnosis to the start of surgery. Age should not delay an individual from receiving timely transfer to a tertiary center for a higher level of care to better assess the patient's operative candidacy and determine appropriate treatment.