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Thorac Cardiovasc Surg
DOI: 10.1055/a-2547-5604
Original Cardiovascular

Do the Frequency of Aortic Dissection Surgery and 30-day Survival Depend on the Day of the Week, Climate Parameters, or Moon Phase?

Andreas Boening
1   Department of Cardiovascular Surgery, Justus—Liebig-University Giessen, Giessen, Germany
,
Marc Brühl
1   Department of Cardiovascular Surgery, Justus—Liebig-University Giessen, Giessen, Germany
,
Christopher Büsch
2   Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
,
Niklas Luther
4   Centre of International Development and Environmental Research, Justus Liebig University Giessen, Giessen, Germany
,
Elena Xoplaki
3   Department of Geography, Climatology, Climate Dynamics and Climate Change, Justus Liebig University Giessen, Giessen, Germany
4   Centre of International Development and Environmental Research, Justus Liebig University Giessen, Giessen, Germany
,
Rawa Arif
5   Department of Cardiac Surgery, Heidelberg University, Heidelberg, Germany
,
Thilo Noack
6   University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
,
Jochen Pöling
7   Department of Cardiac Surgery, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
,
Martin Czerny
8   Department of Cardiovascular Surgery, University Hospital Freiburg, Freiburg, Germany
,
Jens Brickwedel
9   Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg UKE, Hamburg, Germany
,
Sven Peterss
10   Department of Cardiac Surgery, LMU University Hospital Munich, Munich, Germany
,
Tomas Holubec 
11   Department of Cardiovascular Surgery, University Hospital and Goethe University Frankfurt, Frankfurt/Main, Germany
,
Philipp Jawny
12   Department of Cardiothoracic Surgery, University Hospital Augsburg, Augsburg, Germany
,
for the GERAADA Study Group › Author Affiliations
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Abstract

Background

The German Registry of Aortic Dissections Type A (GERAADA) is a large European registry documenting patients with type A aortic dissection who have undergone surgical repair. This analysis investigated a potential association between the incidence of type A dissections (AADA) and lunar cycles, day of the week, or weather conditions.

Methods

Data from 2,388 patients were analyzed for two endpoints: incidence of AADA surgery per day (analyzed using a Poisson regression to account for overdispersed data) and early mortality after surgery (analyzed using a logistic mixed regression to account for center heterogeneity). In both models, the influence of weather conditions (season, temperature, temperature difference, radiation, and synoptic conditions), moon phase, and weekday of operation was examined.

Results

The occurrence of AADA surgery was similar between weekdays (Monday to Friday), but less frequent on weekends. The 30-day mortality odds ratio was higher for surgeries performed on weekends than on weekdays. Operations were more frequent in winter than in other seasons. The occurrence of surgery or early mortality after surgery was not associated with synoptic weather conditions. Mean daily temperature and global radiation were not found to be different between survivors and patients with early deaths. No significant association was found between the moon phase and the occurrence or the outcome of surgery.

Conclusion

The occurrence of AADA surgery was higher during winter, with colder mean temperatures, and lower on weekends than on weekdays. Mortality after surgery on weekends was higher than after surgery on weekdays.

Keywords

acute aortic dissection type A - GERAADA - moon phases - weather - weekend

Supplementary Material



Publication History

Received: 17 October 2024

Accepted: 25 February 2025

Accepted Manuscript online:
28 February 2025

Article published online:
15 April 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Erbel R, Aboyans V, Boileau C. et al; ESC Committee for Practice Guidelines, The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. Eur Heart J 2014; 35 (41) 2873-2926 . Erratum in: Eur Heart J. 2015 Nov 1;36(41):2779. PMID: 25173340
    Search in Google Scholar
  • 2 Manfredini R, Boari B, Gallerani M. et al. Chronobiology of rupture and dissection of aortic aneurysms. J Vasc Surg 2004; 40 (02) 382-388
    Search in Google Scholar
  • 3 Manfredini R, Portaluppi F, Salmi R. et al. Seasonal variation in the occurrence of nontraumatic rupture of thoracic aorta. Am J Emerg Med 1999; 17 (07) 672-674
    Search in Google Scholar
  • 4 Vitale J, Manfredini R, Gallerani M. et al. Chronobiology of acute aortic rupture or dissection: a systematic review and a meta-analysis of the literature. Chronobiol Int 2015; 32 (03) 385-394
    Search in Google Scholar
  • 5 Mehta RH, Manfredini R, Bossone E. et al; International Registry of Acute Aortic Dissection (IRAD) Investigators. The winter peak in the occurrence of acute aortic dissection is independent of climate. Chronobiol Int 2005; 22 (04) 723-729
    Search in Google Scholar
  • 6 Siddiqi HK, Luminais SN, Montgomery D. et al; GenTAC and IRAD investigators. Chronobiology of acute aortic dissection in the Marfan syndrome (from the National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions and the International Registry of Acute Aortic Dissection). Am J Cardiol 2017; 119 (05) 785-789
    Search in Google Scholar
  • 7 Benouaich V, Soler P, Gourraud PA, Lopez S, Rousseau H, Marcheix B. Impact of meteorological conditions on the occurrence of acute type A aortic dissections. Interact Cardiovasc Thorac Surg 2010; 10 (03) 403-406
    Search in Google Scholar
  • 8 Manfredini R, Fabbian F, Manfredini F, Salmi R, Gallerani M, Bossone E. Chronobiology in aortic diseases—“is this really a random phenomenon?”. Prog Cardiovasc Dis 2013; 56 (01) 116-124
    Search in Google Scholar
  • 9 Gallerani M, Volpato S, Boari B. et al. Outcomes of weekend versus weekday admission for acute aortic dissection or rupture: a retrospective study on the Italian National Hospital Database. Int J Cardiol 2013; 168 (03) 3117-3119
    Search in Google Scholar
  • 10 Bjursten H, Oudin Åström D, Nozohoor S. et al. Once after a full moon: acute type A aortic dissection and lunar phases. Interact Cardiovasc Thorac Surg 2022; 34 (01) 105-110
    Search in Google Scholar
  • 11 Deutscher Wetterdienst (DWD). Großwetterlagen. Accessed November 5, 2023 at: https://www.dwd.de/DE/leistungen/grosswetterlage/grosswetterlage.html , last visited 05.11. 2023
  • 12 Gerstengarbe FW, Werner PC. . PIK Report No. 100: Katalog der Grosswetterlagen Europas (1881–2004) nach Paul Hess und Helmut Brezowsky 6., verbesserte und ergänzte Auflage. S11f. Potsdamer Institut für Klimafolgenforschung. 2005
  • 13 Deutscher Wetterdienst (DWD) Climate Data Center (CDC): Historische stündliche Stationsmessungen der Lufttemperatur und Luftfeuchte für Deutschland, Version v006, 2018, bearbeitet, gemittelte Daten, last visited November 3, 2022
  • 14 Deutscher Wetterdienst (DWD) Climate Data Center (CDC): Stündliche Stationsmessungen der Solarstrahlung (global/diffus) und der atmosphärischen Gegenstrahlung für Deutschland, Version recent, bearbeitet, gemittelte Daten, abgerufen am 03.11. 2022
  • 15 Deutscher Wetterdienst. Wetter- und Klimalexikon. Großwetterlage. Deutscher Wetterdienst. Accessed April 15, 2024 at: https://www.dwd.de/DE/service/lexikon/Functions/glossar.html?lv3=101084&lv2=100932
  • 16 Deutscher Wetterdienst (DWD): Raster data set of daily mean temperature in °C for Germany - HYRAS-DE-TAS, Version v5.0, last visited November 5, 2023
  • 17 Deutscher Wetterdienst (DWD): Raster data set of daily mean global radiation in W/m 2 for Germany - HYRAS-DE-RSDS, Version v3.0, last visited November 5, 2023
  • 18 Conzelmann LO, Weigang E, Mehlhorn U. et al; GERAADA Investigators. Mortality in patients with acute aortic dissection type A: analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA). Eur J Cardiothorac Surg 2016; 49 (02) e44-e52
    Search in Google Scholar
  • 19 Mehta RH, Manfredini R, Bossone E. et al. Does circadian and seasonal variation in occurrence of acute aortic dissection influence in-hospital outcomes?. Chronobiol Int 2005; 22 (02) 343-351
    Search in Google Scholar
  • 20 Oudin A, Bjursten H, Oudin Åström D. et al. Impact of national holidays and weekends on incidence of acute type A aortic dissection repair. Sci Rep 2022; 12 (01) 20552
    Search in Google Scholar
  • 21 Henzi D, Platzmann A, Brtek J. et al. Increasing atmospheric temperature implicates increasing risk for acute type A dissection in hypertensive patients. J Thorac Dis 2021; 13 (10) 5799-5806
    Search in Google Scholar
  • 22 Taheri Shahraiyni H, Sodoudi S, Cubasch U. Weather conditions and their effect on the increase of the risk of type A acute aortic dissection onset in Berlin. Int J Biometeorol 2016; 60 (08) 1303-1305
    Search in Google Scholar
  • 23 Oudin Åström D, Bjursten H, Oudin A. et al. Temperature effects on incidence of surgery for acute type A aortic dissection in the Nordics. Glob Health Action 2022; 15 (01) 2139340
    Search in Google Scholar
  • 24 Majd P, Madershahian N, Sabashnikov A. et al. Impact of meteorological conditions on the incidence of acute aortic dissection. Ther Adv Cardiovasc Dis 2018; 12 (12) 321-326
    Search in Google Scholar