Interinstitutional analysis of the outcome after surgery for type A aortic dissection
-
Published:2023-02-24
Issue:4
Volume:49
Page:1791-1801
-
ISSN:1863-9933
-
Container-title:European Journal of Trauma and Emergency Surgery
-
language:en
-
Short-container-title:Eur J Trauma Emerg Surg
Author:
Biancari FaustoORCID, Dell’Aquila Angelo M., Gatti Giuseppe, Perrotti Andrea, Hervé Amélie, Touma Joseph, Pettinari Matteo, Peterss Sven, Buech Joscha, Wisniewski Konrad, Juvonen Tatu, Jormalainen Mikko, Mustonen Caius, Rukosujew Andreas, Demal Till, Conradi Lenard, Pol Marek, Kacer Petr, Onorati Francesco, Rossetti Cecilia, Vendramin Igor, Piani Daniela, Rinaldi Mauro, Ferrante Luisa, Quintana Eduard, Pruna-Guillen Robert, Lega Javier Rodriguez, Pinto Angel G., Acharya Metesh, El-Dean Zein, Field Mark, Harky Amer, Kuduvalli Manoj, Nappi Francesco, Gerelli Sebastien, Di Perna Dario, Mazzaro Enzo, Rosato Stefano, Fiore Antonio, Mariscalco Giovanni
Abstract
Abstract
Purpose
To evaluate the impact of individual institutions on the outcome after surgery for Stanford type A aortic dissection (TAAD).
Methods
This is an observational, multicenter, retrospective cohort study including 3902 patients who underwent surgery for TAAD at 18 university and non-university hospitals.
Results
Logistic regression showed that four hospitals had increased risk of in-hospital mortality, while two hospitals were associated with decreased risk of in-hospital mortality. Risk-adjusted in-hospital mortality rates were lower in four hospitals and higher in other four hospitals compared to the overall in-hospital mortality rate (17.7%). Participating hospitals were classified as overperforming or underperforming if their risk-adjusted in-hospital mortality rate was lower or higher than the in-hospital mortality rate of the overall series, respectively. Propensity score matching yielded 1729 pairs of patients operated at over- or underperforming hospitals. Overperforming hospitals had a significantly lower in-hospital mortality (12.8% vs. 22.2%, p < 0.0001) along with decreased rate of stroke and/or global brain ischemia (16.5% vs. 19.9%, p = 0.009) compared to underperforming hospitals. Aggregate data meta-regression of the results of participating hospitals showed that hospital volume was inversely associated with in-hospital mortality (p = 0.043). Hospitals with an annual volume of less than 15 cases had an increased risk of in-hospital mortality (adjusted OR, 1.345, 95% CI 1.126–1.607).
Conclusion
The present findings indicate that there are significant differences between hospitals in terms of early outcome after surgery for TAAD. Low hospital volume may be a determinant of poor outcome of TAAD.
Trial registration
ClinicalTrials.gov Identifier: NCT04831073.
Funder
University of Helsinki including Helsinki University Central Hospital
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine,Orthopedics and Sports Medicine,Emergency Medicine,Surgery
Reference8 articles.
1. Benedetto U, Dimagli A, Kaura A, et al. Determinants of outcomes following surgery for type A acute aortic dissection: the UK National Adult Cardiac Surgical Audit. Eur Heart J. 2021;43:44–52. https://doi.org/10.1093/eurheartj/ehab586. 2. Larsen M, Trimarchi S, Patel HJ, et al. Extended versus limited arch replacement in acute Type A aortic dissection. Eur J Cardiothorac Surg. 2017;52:1104–10. https://doi.org/10.1093/ejcts/ezx214. 3. Mariscalco G, Maselli D, Zanobini M, et al. Aortic centres should represent the standard of care for acute aortic syndrome. Eur J Prev Cardiol. 2018;25(1_suppl):3–14. https://doi.org/10.1177/2047487318764963. 4. Biancari F, Mariscalco G, Yusuff H, et al. European registry of type A aortic dissection (ERTAAD)—rationale, design and definition criteria. J Cardiothorac Surg. 2021;16(1):171. https://doi.org/10.1186/s13019-021-01536-5. 5. Brescia AA, Patel HJ, Likosky DS, et al. Volume-outcome relationships in surgical and endovascular repair of aortic dissection. Ann Thorac Surg. 2019;108:1299–306. https://doi.org/10.1016/j.athoracsur.2019.06.047.
Cited by
3 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献
|
|