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Background: There is a paucity of contemporary population-based studies on temporal trends in incidence and early complications after open thoracic aortic surgery. This study aimed to assess temporal trends in incidence and early complications of open aortic surgery for ascending aortic aneurysm or dissection in Sweden.

Methods: All open thoracic aortic operations for aortic aneurysm or dissection involving the ascending aorta, in Sweden from 2001 to 2020 were included in a nationwide, population-based, observational cohort study. Individual patient data were collected from the SWEDEHEART registry, the National Patient Registry, and the National Cause of Death Register. The incidences of surgery, early postoperative mortality, and stroke rates over time were compared using generalized additive models, separately for patients operated for aneurysms and dissections.

Findings: A total of 10,089 procedures in 9829 patients were included. In total, 6429/10,089 operations were performed for aneurysms (63.7%) and 3660/10,089 for dissections (36.3%). The annual incidence of open thoracic aortic operations increased from 26.7 per million inhabitants in 2001 to 64.0 in 2020 (p for trend <0.001). Crude 30-day mortality after first-time surgery was 2.4% (95% confidence interval (CI) 2.0–2.9) for aneurysms and 14.6% (95% CI 13.4–15.8) for dissections. The age- and sex-adjusted 30-day mortality risk for first-time surgery for aneurysm decreased over time (adjusted odds ratio (aOR) 0.33, 95% CI 0.14–0.77) while stroke risk showed a tendency toward decrease (aOR 0.42, 95% CI 0.17–1.06). For first-time surgery for dissections, adjusted 30-day mortality risk decreased significantly (aOR 0.40, 95% CI 0.25–0.64), whereas stroke risk did not change (aOR 1.05, 95% CI 0.64–1.72).

Interpretation: The incidence of open thoracic aortic surgery in Sweden for aneurysm and dissection involving the ascending aorta, more than doubled over two decades. Survival after aneurysm and dissection surgery improved during the study period.