The case counts of acute aortic syndromes exhibit significant temporal and seasonal variation, with a distinct late-autumn and early-winter peak and significant declines during institutional vacation periods, suggesting that acute cardiovascular events are modulated by cyclical environmental and socio-systemic factors.
Key Findings
Results
The annual number of acute aortic syndrome (AAS) cases at a single maximal care centre showed a steady increasing trend over 20 years, peaking in 2017.
Retrospective cohort of 403 patients admitted with confirmed AAS between 2005 and 2025 at University Hospital Erlangen, Germany.
All diagnoses were established by computed tomography angiography (CTA) and confirmed intraoperatively.
Annual, quarterly, and monthly surgical volumes were analyzed with Poisson and negative binomial regression models.
Results
AAS cases were significantly more frequent in the fourth quarter (October-December) than in the second and third quarters.
The abstract reports a statistically significant dominance of Q4 cases (p < 0.05) compared with Q2 and Q3.
Analysis was based on quarterly distributions of surgical case volumes from 2005 to 2025.
Results
Monthly analysis showed a prominent peak in AAS cases in October.
Incidence rate ratio (IRR) = 1.85 for October versus June (p < 0.05).
Monthly counts were modelled using Poisson and negative binomial regression.
Results
Fixed public holidays and school vacations were associated with significantly fewer daily AAS admissions.
Reductions in daily admission counts were statistically significant (p < 0.05).
The lowest relative case counts occurred during the Christmas vacation period (IRR: 0.40-0.50).
Conclusions
The authors conclude that AAS occurrence is modulated by cyclical environmental and socio-systemic factors.
The pattern was a distinct late-autumn and early-winter peak alongside significant declines during institutional vacation periods.
The study is single-centre and retrospective, and the stated aim included exploring chronological and environmental contributors to variation.
What This Means
This study looked back at 403 patients treated for acute aortic syndromes, which are life-threatening tears or ruptures in the body's main artery, at one large German university hospital between 2005 and 2025. The researchers examined when during the year and across the 20-year period patients were admitted.
They found that the number of cases rose steadily over the years, peaking in 2017. Cases clustered in the last three months of the year, with October standing out: the rate was about 1.85 times that of June. In contrast, fewer patients were admitted on public holidays and during school vacations, with the lowest numbers around Christmas (roughly 40-50% of the expected rate).
This research suggests that both seasonal and environmental factors and the way healthcare systems and society operate may influence when these emergencies are seen. Because it comes from a single hospital and is retrospective, it cannot prove the causes of these patterns, and the holiday dips may partly reflect patterns of referral and access rather than true changes in disease occurrence.
Groß R, Elbayomi M, Harig F, Mellert F, Cesnjevar R, Pathare P. (2026). The law of surprise: temporal variation and seasonality of acute aortic syndromes: a single-centre epidemiologic cohort analysis spanning 20 years.. Journal of cardiothoracic surgery. https://doi.org/10.1186/s13019-026-04750-1