What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Stanford Type A Aortic Dissection (n=208). Primary outcome: Return to Work status.

What does this research mean for the field?

The return to work rate among young and middle-aged patients with Stanford Type A aortic dissection after cardiac surgery is low (39.4%), and is significantly influenced by factors such as return-to-work self-efficacy, social support, and NYHA functional class. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

March 13, 2026Open Access

Return to Work Status and Influencing Factors Among Young and Middle-Aged Patients with Stanford Type A Aortic Dissection After Cardiac Surgery: A Random Forest Model Analysis

Key Result

Return to work rate was 39.4% among young and middle-aged STAAD patients after cardiac surgery, indicating a low success rate in returning to work.

Key Points

Investigate return to work status and influencing factors among young and middle-aged patients with Stanford Type A aortic dissection after cardiac surgery.
Conducted a cross-sectional study with 208 participants
Utilized various questionnaires including the Return-to-Work Self-Efficacy Questionnaire
Performed univariate analyses and binary logistic regression
Employed a random forest model for identifying influencing factors
39.4% of participants returned to work
Independent factors for return to work included being a primary household breadwinner, non-manual work, and return-to-work self-efficacy
NYHA functional class III was negatively associated with return to work

Study Design

Type

Cross-Sectional (n=208)

Multicenter

Structured PICO

Population

208 young and middle-aged adults (aged 18-59 years) who underwent open-chest cardiac surgery for Stanford Type A aortic dissection (STAAD) at least 3 months prior, employed before STAAD, hemodynamically stable, and with NYHA functional class I-III.

Outcome

Return to work (RTW) status at approximately 3 months after hospital dischargepatient reported

The return-to-work rate among young and middle-aged patients 3 months after surgery for Stanford Type A aortic dissection is low (39.4%), with self-efficacy, social support, and NYHA class being key modifiable or identifiable predictors.

Limitations

Cross-sectional design limits causal inferences
Data collected via self-reported questionnaires may be biased.
Single time point assessment does not capture changes over time.

Abstract

Purpose: To investigate the current status of return to work (RTW) and its influencing factors among young and middle-aged patients with Stanford Type A aortic dissection (STAAD) after cardiac surgery. Methods: A cross-sectional study was conducted, encompassing a sample of 208 participants who underwent cardiac surgery for STAAD in Guangdong Provincial People’s Hospital from July 2024 to August 2025. All participants completed a general information questionnaire, Return-to-Work Self-Efficacy Questionnaire, Hospital Anxiety and Depression Scale, Brief Illness Perception Questionnaire, and Social Support Rating Scale. Univariate analyses, binary logistic regression analyses, and a random forest model (RFM) were used to identify independent factors influencing RTW. Results: A total of 208 participants completed the assessment, with only 82 (39.4%) returning to work. Binary logistic regression analysis revealed that being the primary household breadwinner (OR = 4.79, 95% CI: 1.70– 13.51), performing non-manual work (OR = 3.96, 95% CI: 1.34– 11.73), objective support (OR = 1.48, 95% CI: 1.03– 2.11), subjective support (OR = 1.54, 95% CI: 1.04– 2.30), return-to-work self-efficacy (OR = 10.68, 95% CI: 4.21– 27.13) and NYHA functional class III (OR = 0.155, 95% CI: 0.03– 0.77) were independent factors influencing RTW in young and middle-aged STAAD patients after cardiac surgery (all P < 0.05). The variable importance ranking for the RFM is as follows: return to work self-efficacy, objective support, subjective support, NYHA functional class, primary household breadwinner, and nature of work. Conclusion: RTW rate among young and middle-aged STAAD patients following cardiac surgery remains low. Early identification of high-risk individuals is crucial for clinical care and rehabilitation planning. These findings provide a basis for developing targeted multidisciplinary rehabilitation strategies aimed at improving outcomes for vocational reintegration. Keywords: aortic dissection, cardiac surgery, return to work, rehabilitation, random forest model

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