PloS one · 2025
Hospital volume and outcomes of surgical repair in type A acute aortic dissection: A nationwide cohort study.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
De León Ayala Iván Alejandro, Chang Feng-Cheng, Chen Chun-Yu, Cheng Yu-Ting, Chan Yi-Hsin, Wu Victor Chien-Chia, Liu Kuo-Sheng, Yeh Chi-Hsiao, Chu Pao-Hsien, Chen Shao-Wei
Аннотация
BACKGROUND: Over the last decade, the number of patients treated with open repair for TAAAD in Taiwan has dramatically increased. This study aims to assess the hospital-volume relationship with surgical outcomes of type A acute aortic dissection (TAAAD) across hospitals in Taiwan.
METHODS: Using the Taiwan National Health Insurance (NHI) Research Database (NHIRD), we include only the patients who underwent first open repair for TAAAD from 01/01/2005, to 31/12/2020, in Taiwan. A total of 8,059 patients in 77 hospitals were eligible for the analysis. Hospitals were categorized based on their 16-year cumulative volume of TAAAD open repair surgeries, and patients were grouped into quartiles accordingly.
RESULTS: Ascending aortic replacement (55.7%) and partial/total arch replacement (38.8%) were the most common methods of open aortic repair. In-hospital mortality was 22% and decreased from 28% in 2005 to 20% in 2020. Greater volume (per 5 annual surgeries) was associated with lower risks of in-hospital mortality (odd ratio 0.90, 95% confidence interval [CI] 0.87-0.92) and mortality after discharge (hazard ratio 0.97, 95% CI 0.95-0.99).
CONCLUSION: Operative volume inversely correlates to in-hospital mortality and postoperative complications. The volume-outcome effect extends after discharge and reflects better long-term survival. Hospital referral to high-volume centers should be considered in patients needing complex open repair for TAAAD.
METHODS: Using the Taiwan National Health Insurance (NHI) Research Database (NHIRD), we include only the patients who underwent first open repair for TAAAD from 01/01/2005, to 31/12/2020, in Taiwan. A total of 8,059 patients in 77 hospitals were eligible for the analysis. Hospitals were categorized based on their 16-year cumulative volume of TAAAD open repair surgeries, and patients were grouped into quartiles accordingly.
RESULTS: Ascending aortic replacement (55.7%) and partial/total arch replacement (38.8%) were the most common methods of open aortic repair. In-hospital mortality was 22% and decreased from 28% in 2005 to 20% in 2020. Greater volume (per 5 annual surgeries) was associated with lower risks of in-hospital mortality (odd ratio 0.90, 95% confidence interval [CI] 0.87-0.92) and mortality after discharge (hazard ratio 0.97, 95% CI 0.95-0.99).
CONCLUSION: Operative volume inversely correlates to in-hospital mortality and postoperative complications. The volume-outcome effect extends after discharge and reflects better long-term survival. Hospital referral to high-volume centers should be considered in patients needing complex open repair for TAAAD.