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

Autor: Fausto Biancari, Angelo M. Dell’Aquila, Giuseppe Gatti, Andrea Perrotti, Amélie Hervé, Joseph Touma, Matteo Pettinari, Sven Peterss, Joscha Buech, Konrad Wisniewski, Tatu Juvonen, Mikko Jormalainen, Caius Mustonen, Andreas Rukosujew, Till Demal, Lenard Conradi, Marek Pol, Petr Kacer, Francesco Onorati, Cecilia Rossetti, Igor Vendramin, Daniela Piani, Mauro Rinaldi, Luisa Ferrante, Eduard Quintana, Robert Pruna-Guillen, Javier Rodriguez Lega, Angel G. Pinto, Metesh Acharya, Zein El-Dean, Mark Field, Amer Harky, Manoj Kuduvalli, Francesco Nappi, Sebastien Gerelli, Dario Di Perna, Enzo Mazzaro, Stefano Rosato, Antonio Fiore, Giovanni Mariscalco
Rok vydání: 2023
Předmět:
Zdroj: European Journal of Trauma and Emergency Surgery.
ISSN: 1863-9941
1863-9933
DOI: 10.1007/s00068-023-02248-2
Popis: 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 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.
Databáze: OpenAIRE
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