BACKGROUND: The outcomes after prolonged treatment in the intensive care unit (ICU) after surgery for Stanford type A aortic dissection (TAAD) have not been previously investigated. METHODS: This analysis included 3538 patients from a multicenter study who underwent surgery for acute TAAD and were admitted to the cardiac surgical ICU. RESULTS: The 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). CONCLUSIONS: Prolonged 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.

Cardiothoracic Department Azienda Sanitaria Universitaria Friuli Centrale Udine Italy

Department of Cardiac Surgery 3rd Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic

Department of Cardiac Surgery Centre Hospitalier Annecy Genevois Epagny Metz Tessy France

Department of Cardiac Surgery Glenfield Hospital Leicester UK

Department of Cardiac Surgery Henri Mondor University Hospitals Assistance Publique Hôpitaux de Paris Creteil France

Department of Cardiac Surgery LMU University Hospital Ludwig Maximilian University Munich Germany

Department of Cardiac Surgery Martin Luther University Halle Wittenberg Halle Germany

Department of Cardiac Surgery Molinette Hospital University of Turin Turin Italy

Department of Cardiac Surgery Ziekenhuis Oost Limburg Genk Belgium

Department of Cardiothoracic Surgery University Hospital Muenster Muenster Germany

Department of Cardiovascular Surgery Clinical Hospital of Barcelona University of Barcelona Barcelona Spain

Department of Cardiovascular Surgery University Heart and Vascular Center Hamburg Hamburg Germany

Department of Cardiovascular Surgery University Hospital Gregorio Marañón Madrid Spain

Department of Medicine South Karelia Central Hospital University of Helsinki Lappeenranta Finland

Department of Thoracic and Cardiovascular Surgery University of Franche Comte Besancon France

Division of Cardiac Surgery Cardio Thoracic and Vascular Department Azienda Sanitaria Universitaria Giuliano Isontina Trieste Italy

Division of Cardiac Surgery University of Verona Medical School Verona Italy

German Centre for Cardiovascular Research Partner Site Munich Heart Alliance Munich Germany

Heart and Lung Center Helsinki University Hospital University of Helsinki Helsinki Finland

Liverpool Centre for Cardiovascular Sciences Liverpool Heart and Chest Hospital Liverpool UK

Research Unit of Surgery Anesthesia and Critical Care University of Oulu Oulu Finland

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