title: Effects of a protocol-based management of type A aortic dissections.
abstract: BACKGROUND
  Ascending aortic dissections (AADs) require prompt diagnosis and surgical treatment. We present the results of implementing a multidisciplinary aortic dissection protocol on the outcomes of AAD treatment at a nonteaching hospital.
  
  
  METHODS
  From January 2002-December 2013, 54 patients with the diagnosis of AAD were treated at our institution. Thirty-seven (68.5%) were male with a mean age of 62.3 y. Cardiogenic shock was present in 25.9% of patients. An AAD protocol, focused on educating physicians on presenting signs and symptoms, adequate triaging, and the need for immediate surgical intervention, was implemented, alongside the standardization of surgical treatment. We divided the cohort into two eras, based on AAD program's implementation in 2006, to better assess the impact of this protocol.
  
  
  RESULTS
  Patients from the early era had significantly longer time from Emergency Department to the operating room, more postoperative occurrence of prolonged ventilation, and a longer postoperative hospital stay at 8.7 ± 8 versus 3.1 ± 2.6 h (P = 0.002), 63% versus 18% (P = 0.002), and 63% versus 18% (P = 0.002), respectively. The overall mortality for the cohort was 9.3%, decreasing from 12.5% before 2006 to 7.9% after 2006.
  
  
  CONCLUSIONS
  The implementation of a multidisciplinary aortic dissection protocol has resulted in faster diagnosis and transport of AAD cases from the emergency room to the operating room, improving outcomes. Our data support the concept that nonteaching institutions can deliver excellent care to patients with acute aortic emergencies.
authors.affiliation: The Valley Hospital, The Valley Heart Center, Ridgewood, New Jersey; Columbia University, College of Physicians and Surgeons, New York, New Jersey; The University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania. Electronic address: jbg2136@columbia.edu.
authors.forename: Juan B
authors.initials: JB
authors.lastname: Grau
authors.affiliation: The Valley Hospital, The Valley Heart Center, Ridgewood, New Jersey.
authors.forename: Cyrus E
authors.initials: CE
authors.lastname: Kuschner
authors.affiliation: The Valley Hospital, The Valley Heart Center, Ridgewood, New Jersey; The University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ferrari
authors.affiliation: The Valley Hospital, The Valley Heart Center, Ridgewood, New Jersey.
authors.forename: Sean R
authors.initials: SR
authors.lastname: Wilson
authors.affiliation: The Valley Hospital, The Valley Heart Center, Ridgewood, New Jersey.
authors.forename: Mariano E
authors.initials: ME
authors.lastname: Brizzio
authors.affiliation: The Valley Hospital, The Valley Heart Center, Ridgewood, New Jersey.
authors.forename: Alex
authors.initials: A
authors.lastname: Zapolanski
authors.affiliation: The Valley Hospital, Emergency Department, Ridgewood, New Jersey.
authors.forename: Joseph
authors.initials: J
authors.lastname: Yallowitz
authors.affiliation: The Valley Hospital, The Valley Heart Center, Ridgewood, New Jersey.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Shaw
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D002985:Clinical Protocols; D003661:Decision Support Techniques; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
keywords: Clinical protocol; Mortality; Nonteaching hospital; Time to surgery; Type A dissection