Alcohol use disorder is associated with a lower risk of in-hospital mortality in type A aortic dissection repair: a population-based study of National Inpatient Sample from 2015–2020

• Published in: Alcohol and alcoholism (Oxford) 2024-07, Vol.59 (5)
• Main Authors: Li, Renxi, Huddleston, Stephen J, Prastein, Deyanira J
• Format: Article
• Language: English
• Subjects: Adult; Aged; Alcoholism - complications; Alcoholism - epidemiology; Alcoholism - mortality; Aortic Dissection - epidemiology; Aortic Dissection - mortality; Aortic Dissection - surgery; Female; Hospital Mortality; Humans; Inpatients; Male; Middle Aged; Postoperative Complications - epidemiology; Postoperative Complications - mortality; United States - epidemiology
• ISSN: 0735-0414; 1464-3502; 1464-3502
• DOI: 10.1093/alcalc/agae061

Abstract Background While alcohol consumption is implicated in the development of aortic dissection, the impact of alcohol use disorder (AUD) on the outcomes of type A aortic dissection (TAAD) repair is still largely unexplored. This study aimed to conduct a comprehensive, population-based analysis of effect of AUD on in-hospital outcomes following TAAD repair using National/Nationwide Inpatient Sample, the largest all-payer database in the United States. Methods Patients undergoing TAAD repair were identified in National/Nationwide Inpatient Sample from Q4 2015–2020. Demographics, comorbidities, hospital characteristics, primary payer status, and transfer-in status between patients with and without AUD were matched by a 1:3 propensity-score matching. In-hospital outcomes were examined. Results There were 220 patients with AUD who underwent TAAD repair. Meanwhile, 4062 non-AUD patients went under TAAD repair, where 646 of them were matched to all AUD patients. After propensity-score matching, AUD patients had a lower risk of in-hospital mortality (7.76% vs 13.31%, P = 0.03) while there was no difference in transfer-in status or time from admission to operation. However, patients with AUD had a higher rate of respiratory complications (27.40% vs 19.66%, P = 0.02) and a longer hospital length of stay (16.20 ± 11.61 vs 11.72 ± 1.69 days, P = 0.01). All other in-hospital outcomes were comparable between AUD and non-AUD patients. Conclusion AUD patients had a lower risk of in-hospital mortality but a higher rate of respiratory complications and a longer LOS. These findings can provide insights into preoperative risk stratification of these patients. Nonetheless, reasons underlying the lower mortality rate in AUD patients and their long-term prognosis require further investigation. Short Summary: This study conducted a comprehensive, population-based analysis of the effects of alcohol use disorder (AUD) on in-hospital outcomes following type A aortic dissection repair using the National/Nationwide Inpatient Sample database, the largest all-layer database in the United States. Patients with AUD were found to have a lower risk of in-hospital mortality compared to their propensity-score-matched non-AUD counterparts, despite no differences in the timeliness of surgical intervention between the groups. However, AUD patients did experience a higher rate of respiratory complications and a longer length of stay.