Abstract: Objective To explore the risk factors for in-hospital death in patients with Stanford type A aortic dissection (TAAD). Methods Online databases of China National Knowledge Infrastructure (CNKI), Wanfang Database, China Biology Medicine disc (CBMdisc), PubMed, EMBASE, Cochrane and Web of Science were searched. All studies on risk factors of postoperative hospital death in patients with TAAD were collected from the establish of database to December 30, 2023. Two independent reviewers screened the studies, extracted data, and evaluated the quality of the studies, while a third reviewer handled the controversial studies. Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included studies. Data was processed using Stata 14.0. Results A total of 23 cohort studies with 10 463 patients were included. The quality scores of the included studies were all above or equal to 6 points. The results of the meta-analysis showed that preoperative stroke (HR=3.62, 95%CI 1.97-6.65, P<0.001), malperfusion of mesenteric artery (HR=3.23, 95%CI 1.94-5.39, P<0.001), malperfusion of coronary (HR=2.80, 95%CI 2.13-3.67, P<0.001), coma (HR=2.30, 95%CI 1.81-2.93, P<0.001), shock (HR=2.24, 95%CI 1.31-3.84,P=0.003), pericardial tamponade (HR=2.09, 95%CI 1.57-2.79, P<0.001), malperfusion of renal artery (HR=1.59, 95%CI 1.04-2.45, P=0.033), coronary heart disease (HR=1.54, 95%CI 1.11-2.13, P<0.001), malperfusion of limb (HR=1.40, 95%CI 1.11-1.77, P=0.004), smoking (HR=1.28, 95%CI 1.06-1.55, P=0.010), age (HR=1.03, 95%CI 1.02-1.04, P<0.001) were risk factors for postoperative in-hospital mortality in TAAD patients. Subgroup analysis showed that the effects of different risk factors on postoperative death risk were not related to regions. Conclusion Preoperative organ or tissue malperfusion, shock,pericardial tamponade, coronary heart disease, smoking, and age are risk factors for in-hospital death in patients with TAAD.