Key result
Prolonged operative duration during thoracic aortic surgery is linked to ~7.2-fold higher in-hospital mortality.
Why the study?
Outcomes data from African populations undergoing thoracic aortic surgery are scarce, necessitating characterization of patient profiles and perioperative outcomes.
Cohort (n=366)
No
In a South African cohort, in-hospital mortality following open thoracic aortic surgery was 21.9%, primarily associated with prolonged operative duration.
May inform perioperative risk stratification in open thoracic aortic surgery; leaves open whether operative duration is causal or modifiable.
Background Thoracic aortic diseases require complex surgery, and outcomes data from African populations are scarce. We described the patient characteristic profile, documented risk factors, and perioperative outcomes of patients undergoing thoracic aortic surgery at a quaternary hospital in South Africa. Methods In a retrospective cohort study reported per the Strengthening the Reporting of Observational Studies in Epidemiology guidelines, we included patients aged 18 yr or older who underwent open thoracic aortic surgery at Charlotte Maxeke Johannesburg Academic Hospital between 1995 and 2023. The primary outcome was in-hospital mortality. We assessed correlates using modified Poisson regression with robust variance (risk ratios [RRs]). Results Of 366 patients (median age 48 yr [inter-quartile range 37–59]; 219 [59.8%] male), diagnoses were dissection in 157 (42.9%), aneurysm in 157 (42.9%), traumatic rupture in 26 (7.1%), and other in 26 (7.1%). In-hospital mortality was 21.9% (80 of 366; 95% confidence interval [CI] 17.7–26.4) and did not differ significantly across diagnosis groups ( P =0.693), being identical after dissection and aneurysm (22.9% in each). Prolonged operative duration (>600 min) was the only variable independently associated with mortality (adjusted RR 7.2; 95% CI 1.5–34.9), an imprecise, sparse-data estimate. Mortality was numerically higher in female than male patients (26.2% vs 19.2%) but this difference was not significant after adjustment (adjusted RR 1.30; 95% CI 0.89–1.89); age and diagnosis were not independently associated. Conclusions In-hospital mortality after thoracic aortic surgery was 21.9%. Prolonged operative duration was associated with in-hospital mortality, although the estimate was imprecise, and operative duration is likely to be a marker of procedural complexity and adverse intraoperative course rather than an independently modifiable risk factor. The findings support intensive postoperative care.
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Mmabatswa et al. (2026) conducted a cohort in Thoracic aortic diseases (n=366). Prolonged operative duration (>600 min) vs. Shorter operative duration (≤600 min) was evaluated on In-hospital mortality (adjusted RR 7.2, 95% CI 1.5-34.9). Prolonged operative duration (>600 min) during open thoracic aortic surgery was independently associated with higher in-hospital mortality (adjusted RR 7.2; 95% CI 1.5-34.9).
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