Interinstitutional analysis of the outcome after surgery for type A aortic dissection.
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Biancari Fausto, Dell'Aquila Angelo M, Gatti Giuseppe, Perrotti Andrea, Hervé Amélie, Touma Joseph, Pettinari Matteo, Peterss Sven, Buech Joscha, Wisniewski Konrad, Juvonen Tatu, Jormalainen Mikko, Mustonen Caius, Rukosujew Andreas, Demal Till, Conradi Lenard, Pol Marek, Kacer Petr, Onorati Francesco, Rossetti Cecilia, Vendramin Igor, Piani Daniela, Rinaldi Mauro, Ferrante Luisa, Quintana Eduard, Pruna-Guillen Robert, Lega Javier Rodriguez, Pinto Angel G, Acharya Metesh, El-Dean Zein, Field Mark, Harky Amer, Kuduvalli Manoj, Nappi Francesco, Gerelli Sebastien, Di Perna Dario, Mazzaro Enzo, Rosato Stefano, Fiore Antonio, Mariscalco Giovanni
Аннотация
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 < 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).
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.