Emergency department visits after acute aortic syndromes

Objective: Recent reports document a high rate of readmission after hospitalization for acute aortic syndromes (AAS) that include acute aortic dissections, intramural hematomas, or penetrating aortic ulcers. We examined the rate of return to the emergency department (ED) to better understand the utilization of emergent health care services after AAS. Methods: Consecutive patients with AAS admitted to the vascular surgery service from 2004 to 2020 were included. Patients with type A dissections, arch involvement, or chronic aortic pathology were excluded. The primary outcome was ED visits within 90 days of the original hospitalization. Results: The study included 79 subjects (62% men, 38% women; mean age: 64 ± 14 years) with AAS (82% aortic dissections, 11% intramural hematomas, and 6% penetrating aortic ulcers). A total of 54 ED visits related to the AAS occurred within 90 days of the original discharge, each of which incurred a computed tomography angiogram. Twenty-eight (35%) subjects had a mean of 2 ± 2 ED visits, whereas 51 (65%) subjects had no ED visits. Ninety percent (25 of 28) of the first ED visits occurred within 1 month of discharge and 53% (15 of 28) within 1 week. A total of 17 (61%) subjects were readmitted to the hospital from the ED. Four subjects were found to have progression of AAS on imaging studies and underwent thoracic endovascular aortic repair during readmission. Comparing subjects who returned to the ED with those who did not, there were no significant differences in demographics, atherosclerotic risk factors except coronary artery disease, type of AAS, number of antihypertensive medications at admission or discharge, operative intervention, length of initial hospital stay, or discharge status. The chief complaints at the first ED visit were pain (n = 17), uncontrolled hypertension (n = 5), syncope (n = 3), and other (n = 3). Conclusions: These data show that one in three patients with AAS returned to the ED within 90 days of initial discharge. Although returning subjects had a higher number of readmissions, few had progression of AAS that required intervention. Because the vast majority were readmitted for medical therapy, early and frequent clinic follow-up may help decrease ED visits and readmissions after AAS.