Regional travel distance is not associated with operative mortality in acute type A aortic dissection

Objectives Few data are available to examine the impact of travel distance on outcomes in acute type A aortic dissection (ATAAD). We hypothesized that longer travel would increase mortality after ATAAD repair. Methods We studied the impact of travel distance ≤100 miles before ATAAD repair between July 2011 and September 2022 using a regional collaborative database. Patients were stratified into quartiles, and the longest and shortest distance quartiles were compared. High-volume centers were defined as those averaging >10 ATAAD repairs annually. Multivariable and hierarchical logistic regression models were fit to identify preoperative and intraoperative risk factors associated with operative mortality. Results We identified 1285 patients who underwent ATAAD repair: 320 in the longest-distance quartile and 335 in the shortest. The longest-distance quartile had greater hospital transfer rates (76% vs 26%, P < .001). There was no difference in major morbidity (52% vs 53%, P = .78) or operative mortality (22% vs 22%, P = .95). High-volume centers were associated with lower mortality (odds ratio [OR], 0.68; 95% CI, 0.46-0.99; P = .048). Age (OR, 1.03; 95% CI, 1.01-1.04, P < .001), cardiopulmonary resuscitation (OR, 2.73; 95% CI, 1.31-5.69, P = .007), cardiogenic shock (OR, 1.99; 95% CI, 1.24-3.22, P = .005), longer cardiopulmonary bypass time (OR, 1.01; 95% CI, 1.01-1.01, P < .001), greater temperature nadir (OR, 1.05; 95% CI, 1.01-1.09, P = .006), and intraoperative blood transfusion (OR, 1.16; 95% CI, 1.08-1.24, P < .001) were associated with greater mortality. Distance (OR, 0.99; 95% CI, 0.98-1.00; P = .073) and hospital transfers (OR, 1.08 95% CI, 0.74-1.58; P = .69) were nonsignificant. Conclusions Hospital transfers and travel distances up to 100 miles for ATAAD repair did not increase operative mortality.