Is Rural Status Associated With Adverse Outcomes In Patients Undergoing Surgery For An Acute Type A Aortic Dissection: A Western Australian Study.

Background:Acute Type A Aortic Dissection (TAAD) represents a cardiothoracic emergency and should be managed without delay. Western Australia is an expansive state with a network of regional centres and cardiothoracic centres located in the capital Perth. The aim of this study is to assess the differences in presentation and outcomes between rural and urban patients undergoing emergent repair for an acute TAAD. Methods: We performed a retrospective analysis of all patients undergoing emergent repair of a TAAD at Fiona Stanley Hospital between 2015 to 2020. A number of variables associated with the patient’s geography, physiology, and postoperative outcome were assessed. Univariate and multivariate logistical regression analysis was performed to evaluate significant differences between the cohorts. Results:A total of 64 patients underwent emergent repair of a TAAD between 2015 – 2020. The overall 30-day mortality rate was 20%. The 30-day mortality rate in the rural cohort was higher than the urban cohort (30% vs 16%) however this was not statistically significant. The rural cohort faced a higher median time to surgery (12 vs 6 hours, P = 0.002) and are likely to require transfer between more than two centres (7 vs 1, P = 0.001). Rural patients were also more likely to require resuscitation perioperatively (OR 4.33, P = 0.013) and more likely to require return to theatre post operatively (OR 7.60, P = 0.002). Both return to theatre and multi-hospital transfer were associated with rural status in multivariate analysis. ConclusionRural patients wait twice as long for definitive surgery as their urban counterparts and require multi-hospital transfer. Rural patients are more likely to present in a critical peri-operative state requiring resuscitation, and have a significantly higher risk of returning to theatre post operatively.