Abstract
Surgery for acute type A aortic dissection is associated with several perioperative complications, such as acute respiratory dysfunction (ARD). The aim of this study was to investigate perioperative risk factors involved in the development of ARD and whether antibiotic treatment has an impact. 243 patients underwent surgery for acute type A aortic dissection between 2008 and 2017. The patients were retrospectively divided into the ARD and NON-ARD group. ARD was defined as PaO2/FiO2 ≤ 200 mmHg (PF ratio) within 48 hours after surgery. All patients received either narrow- or broad-spectrum antibiotics. After the exclusion of 42 patients, 201 patients were analyzed. The PF ratio of the ARD group was significantly lower than of the NON-ARD group within the first 7 days. ARD patients (n = 111) were significantly older (p = .031) and had a higher body mass index (BMI) (p = .017). ARD patients required longer postoperative ventilation (2493 vs. 4695 [min], p = .006) and spent more days in the intensive care unit (7.0 vs. 8.9 [days], p = .043) compared to NON-ARD. The mortality was significantly lower for ARD than for NON-ARD patients (p = .030). The incidence of pneumonia was independent of the antibiotic treatment regime (p = .391). Renal and neurological complication rate was higher in patients treated with broad-spectrum antibiotic. ARD is the main complication (55%) that occurs approximately 24 hours after surgery for acute type A aortic dissection. The preoperative risk factors for ARD were higher age and increased BMI. Patients on broad-spectrum antibiotics did not show an improved postoperative outcome compared to patients with narrow-spectrum antibiotics.
Highlights
Acute type A aortic dissection is a life-threatening disease with an incidence of approximately 2–16 cases/100 000 inhabitants in Europe per year and a preoperative mortality of approximately 17.6% [1,2,3]
Patients on broad-spectrum antibiotics did not show an improved postoperative outcome compared to patients with narrow-spectrum antibiotics
We investigated whether the incidence and development of acute respiratory dysfunction (ARD) is influenced by the postoperative early use of narrow-spectrum vs. broad-spectrum antibiotics
Summary
Acute type A aortic dissection is a life-threatening disease with an incidence of approximately 2–16 cases/100 000 inhabitants in Europe per year and a preoperative mortality of approximately 17.6% [1,2,3]. After the patient survived surgery, there is still a high in-hospital mortality of more than 25% [4]. The high mortality rate is caused by various perioperative complications [5, 6]. One of the major and most frequent complications is acute respiratory dysfunction (ARD). 13% of these patients suffer from ARD, which usually occurs within the first 72 hours after surgery [7]. The consequences of pulmonary dysfunction are a prolonged stay in the intensive care unit (ICU), longer time of mechanical ventilation, higher risk of pneumonia, higher hospital costs and an increased rate of in-hospital mortality [8]. Neither the pathophysiology of ARD nor its risk factors are well understood
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