Interinstitutional analysis of the outcome after surgery for type A aortic dissection



Biancari, Fausto, Dell'Aquila, Angelo M, Gatti, Giuseppe, Perrotti, Andrea, Herve, Amelie, Touma, Joseph, Pettinari, Matteo, Peterss, Sven, Buech, Joscha, Wisniewski, Konrad
et al (show 30 more authors) (2023) Interinstitutional analysis of the outcome after surgery for type A aortic dissection. EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY, 49 (4). pp. 1791-1801.

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Abstract

<h4>Purpose</h4>To evaluate the impact of individual institutions on the outcome after surgery for Stanford type A aortic dissection (TAAD).<h4>Methods</h4>This is an observational, multicenter, retrospective cohort study including 3902 patients who underwent surgery for TAAD at 18 university and non-university hospitals.<h4>Results</h4>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).<h4>Conclusion</h4>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.<h4>Trial registration</h4>ClinicalTrials.gov Identifier: NCT04831073.

Item Type: Article
Uncontrolled Keywords: Type A aortic dissection, Aortic dissection, Volume
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User: Symplectic Admin
Date Deposited: 17 Apr 2023 09:46
Last Modified: 06 Sep 2023 08:50
DOI: 10.1007/s00068-023-02248-2
Open Access URL: https://doi.org/10.1007/s00068-023-02248-2
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3169606