Hospital volume and outcomes of surgical repair in type A acute aortic dissection: A nationwide cohort study.

Hospital volume and outcomes of surgical repair in type A acute aortic dissection: A nationwide cohort study.

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<h4>Background</h4>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....

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Main Authors: Iván Alejandro De León Ayala, Feng-Cheng Chang, Chun-Yu Chen, Yu-Ting Cheng, Yi-Hsin Chan, Victor Chien-Chia Wu, Kuo-Sheng Liu, Chi-Hsiao Yeh, Pao-Hsien Chu, Shao-Wei Chen
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2025-01-01
Series:PLoS ONE
Online Access:https://doi.org/10.1371/journal.pone.0325689
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Summary:<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusion</h4>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.
ISSN:1932-6203

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