Acute type A aortic dissection in the United Kingdom: Surgeon volume-outcome relation

Bashir, Mohamad, Harky, Amer ORCID: 0000-0001-5507-5841, Fok, Matthew ORCID: 0000-0003-4091-6569, Shaw, Matthew ORCID: 0000-0001-9184-5591, Hickey, Graeme L ORCID: 0000-0002-4989-0054, Grant, Stuart W, Uppal, Rakesh and Oo, Aung
(2017) Acute type A aortic dissection in the United Kingdom: Surgeon volume-outcome relation. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 154 (2). 398-+.

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<h4>Objectives</h4>Surgery for acute type A aortic dissection (ATAD) carries a high risk of operative mortality. We examined the surgeon volume-outcome relation with respect to in-hospital mortality for patients presenting with this pathology in the United Kingdom.<h4>Method</h4>Between April 2007 and March 2013, 1550 ATAD procedures were identified from the National Institute for Cardiovascular Outcomes Research database. A total of 249 responsible consultant cardiac surgeons from the United Kingdom recorded 1 or more of these procedures in their surgical activity over this period. We describe the patient population and mortality rates, focusing on the relationship between surgeon volume and in-hospital mortality.<h4>Results</h4>The mean annual volume of procedures per surgeon during the 6-year period ranged from 1 to 6.6. The overall in-hospital mortality rate was 18.3% (283/1550). A mortality improvement at the 95% level was observed with a risk-adjusted mean annual volume >4.5. Surgeons with a mean annual volume <4 over the study period had significantly higher in-hospital mortality rates in comparison with surgeons with a mean annual volume ≥4 (19.3% vs 12.6%; P = .015).<h4>Conclusions</h4>Patients with ATAD who are operated on by lower-volume surgeons experience higher levels of in-hospital mortality. Directing these patients to higher-volume surgeons may be a strategy to reduce in-hospital mortality.

Item Type: Article
Uncontrolled Keywords: aorta, dissection, aneurysm, surgeon volume-outcome, AAD
Depositing User: Symplectic Admin
Date Deposited: 13 Feb 2017 08:32
Last Modified: 19 Jan 2023 07:19
DOI: 10.1016/j.jtcvs.2017.02.015
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