Impact of Age on Survival After Acute Type A Aortic Dissection Repair

BACKGROUND: Acute Type A aortic dissection (ATAAD) remains a surgical emergency with high morbidity and mortality despite improvements in operative management. The influence of age on outcomes among patients undergoing surgical repair remains incompletely characterized. METHODS: Using the Nationwide Inpatient Sample (2010-2018, 2020), we identified adult hospitalizations with a primary diagnosis of ATAAD who underwent surgical repair. Patients were stratified into 3 age groups (<65, 66-75, and >75 years). Weighted analyses compared demographics, comorbidities, hospital characteristics, and outcomes across groups. Multivariable logistic regression identified independent predictors of in-hospital mortality, adjusting for comorbidities and hospital factors. RESULTS: Among 32,798 weighted admissions, 48.1% were aged <65 years, 23.3% were 66-75 years, and 28.6% were >75 years (median age 65 years). Overall, in-hospital mortality was 11.9%, increasing from 8.9% in younger patients to 17.1% in those >75 years (P < 0.001). Older adults had greater comorbidity burden (with most comorbidities differing significantly), shorter median length of stay (5 vs. 6 days, P < 0.001), and lower total hospital charges (P < 0.001). On multivariable analysis, age remained an independent predictor of mortality in patients 66-75 years old (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.34-1.63; P < 0.001) and in patients >75 years (OR, 2.29; 95% CI, 2.10-2.5; P < 0.001). Larger hospitals demonstrated modestly higher adjusted mortality, while hospital teaching status was not independently associated with outcomes. CONCLUSION: Advancing age substantially increases in-hospital mortality after ATAAD repair. These findings emphasize the need for individualized operative decision-making, early referral to experienced centers, and system-level strategies to optimize outcomes for older adults with ATAAD.