Predictors of return to work after open triple-branched stent graft placement for acute type A aortic dissection

Predictors of Return to Work After Thoracic Endovascular Aortic Repair in Patients With Type B Aortic Dissection

OBJECTIVE

Type B aortic dissection (TBAD) is a life-threatening condition, and it takes heavy burden to family and society. Return to work (RTW) not only means patients' physical health but also demonstrates their mental well-being. Thoracic endovascular aortic repair (TEVAR) has been successful in treatment of TBAD patients. However, less studies have addressed on the social functional recovery of TBAD after TEVAR, especially for RTW.

METHODS

From January 1, 2017 to January 1, 2021, TBAD patients who underwent TEVAR and completed a 12-month follow-up were retrospectively enrolled. Primary outcome was RTW. Patients' demographic, sociological, and clinical characteristics, and so on were recorded to analyze and demonstrate independent risk factors for RTW.

RESULTS

Four hundred thirty-two TBAD patients (388 males) were enrolled with a mean age of 48.3±8.9 years (ranged from 19 to 60 years). The 12-month cumulative RTW rate was 62.7% (95% confidence interval [CI]: 57.2%-67.8%). Age <50 years (odds ratio [OR]=3.675, 95% CI: 1.436-9.405) was identified as independent protective factors for RTW, while preoperative job as manual workers (OR=0.101, 95% CI: 0.029-0.353), average annual income, <30 000 Chinese Yuan (CNY) [<4400 US dollar], (OR=0.186, 95% CI: 0.054-0.637), complicated TBAD (malperfusion) (OR=0.246, 95% CI: 0.092-0.659), and distal stent graft-induced new entry (SINE) (OR=0.218, 95% CI: 0.083-0.575, p=0.002) were identified as independent risk factors.

CONCLUSION

Approximately 64% of our patients were able to RTW in the 12 months post-TEVAR for TBAD. Younger patients, patients with less physically demanding jobs, and patients with less complex surgeries were more likely to RTW. Based on these results, more can be done to facilitate the patient's ability and willingness to RTW after TEVAR.

CLINICAL IMPACT

Type B aortic dissection (TBAD) is a life-threatening condition that poses significant burden on both individuals and society. The ability to return to work (RTW) not only reflects the patient's physical health but also indicates their mental well-being. Therefore, identifying risk factors for RTW and promoting the reintegration of TBAD patients into the workforce is crucial in clinical practice.To our knowledge, this study is the first to elucidate and predict the RTW outcomes of TBAD patients who underwent thoracic endovascular aortic repair (TEVAR).

Symptoms of post-traumatic stress disorder and associated risk factors in type A aortic dissection

BACKGROUND

Surgery is the primary option of acute type A aortic dissection (AAAD) treatment. However, the unique traumatic stress of cardiovascular disease and surgery brings physical and psychological suffering to the patients and causes post-traumatic stress disorder (PTSD). The aim of this study was to investigate the rate of PTSD in AAAD patients after surgery and identify the risk factors of this complication.

METHODS

A prospective cohort design was used. All patients who underwent AAAD surgery from September 2017 to June 2019 were included. Resilience, anxiety, and depression level were assessed before patients discharged from the hospital. Additionally, the PTSD symptoms were assessed three months after discharge from hospital. The data were analyzed by SPSS 24.0 (IBM, Armonk, NY, USA) and P<0.05 was considered as statistically significant.

RESULTS

Two hundred and twenty-four patients were included in this study. The incidence of PTSD was 21.4%. Symptoms were highly prevalent with reexperience and increased alertness. "Primary or below" AAAD patients had a significantly higher score in "increased alertness" (P<0.05). Depressive symptoms (B=1.621, β=0.398, P<0.001), female gender (B=-7.539, β=-0.311, P<0.001) were the risk factors associated with PTSD, while optimism (B=-0.920, β=-0.169, P=0.012) was the protective factor in AAAD patients.

CONCLUSIONS

AAAD patients exhibited high prevalence of PTSD, which was highly prevalent with reexperience and increased alertness. Higher depressive level, female gender, and lower optimism were associated with higher risk of PTSD. The findings suggest that medical staff should assess the psychological health status of AAAD patients timely and identify high-risk patients early to improve the outcome.