Outcomes Following Emergent Open Repair for Thoracic Aortic Dissection Are Improved at Higher Volume Centers

• Published in: Journal of cardiac surgery Vol. 30; no. 1; pp. 74 - 79
• Main Authors: Iribarne, Alexander, Milner, Ross, Merlo, Aurelie E., Singh, Ajeet, Saunders, Craig R., Russo, Mark J.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.01.2015
• Subjects: Acute Disease; Adult; Aged; Aneurysm, Dissecting - economics; Aneurysm, Dissecting - epidemiology; Aneurysm, Dissecting - surgery; Aortic Aneurysm, Thoracic - economics; Aortic Aneurysm, Thoracic - epidemiology; Aortic Aneurysm, Thoracic - surgery; Cohort Studies; Comorbidity; Emergency Medical Services - economics; Emergency Medical Services - statistics & numerical data; Female; Hospital Mortality; Humans; Length of Stay - statistics & numerical data; Male; Middle Aged; Patient Discharge - statistics & numerical data; Surgery Department, Hospital - economics; Surgery Department, Hospital - statistics & numerical data; Survival Rate; Treatment Outcome
• ISSN: 0886-0440; 1540-8191
• DOI: 10.1111/jocs.12470

Background Previous studies have demonstrated that patients undergoing complex surgical procedures at high‐volume centers have improved outcomes. The goal of this study was to determine if this volume–outcomes relationship persists at a national level among patients undergoing emergent open repair for thoracic aortic dissection. Methods De‐identified patient‐level data were obtained from the Nationwide Inpatient Sample (2005 to 2008). Patients undergoing emergent aortic surgery for thoracic aortic dissection (n = 1230) were identified by ICD‐9 codes and stratified by annual center volume into low volume (≤5 cases/year), intermediate volume (6 to 10 cases/year), and high volume (≥11 cases/year). The Deyo–Charlson co‐morbidity score was used to adjust for differences in comorbidity between groups. Major outcomes of interest included: in‐hospital morbidity and mortality, length of hospitalization, total hospital costs, and discharge disposition. Results There was a significant association between in‐hospital mortality and center volume (p = 0.014), with low, intermediate, and high‐volume centers having mortality rates of 23.4% (n = 187), 20.1% (n = 62), and 12.1% (n = 15), respectively. This relationship persisted when controlling for severity of co‐morbid illness (p = 0.007). The number of complications per patient varied significantly by center volume (p = 0.044), with a higher proportion of patients at high‐volume centers having no complications. Also, the highest proportion of home discharges was observed among patients at high‐volume centers (p = 0.011). Conclusions Survival following emergent open repair for thoracic aortic dissection was significantly greater at high‐volume centers. These findings suggest that understanding the processes at high‐volume centers that underlie this volume–outcomes relationship may improve in‐hospital survival and postoperative complications. doi: 10.1111/jocs.12470 (J Card Surg 2015;30:74–79)