Hospital volume and outcomes of surgical repair in type A acute aortic dissection: A nationwide cohort study.
<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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Public Library of Science (PLoS)
2025-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0325689 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Iván Alejandro De León Ayala |
| collection | DOAJ |
| description | <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. |
| format | Article |
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| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj-art-bf70a6e95ac641cfb7276f2d579bc68d2025-08-20T02:39:35ZengPublic Library of Science (PLoS)PLoS ONE1932-62032025-01-01206e032568910.1371/journal.pone.0325689Hospital volume and outcomes of surgical repair in type A acute aortic dissection: A nationwide cohort study.Iván Alejandro De León AyalaFeng-Cheng ChangChun-Yu ChenYu-Ting ChengYi-Hsin ChanVictor Chien-Chia WuKuo-Sheng LiuChi-Hsiao YehPao-Hsien ChuShao-Wei Chen<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.https://doi.org/10.1371/journal.pone.0325689 |
| spellingShingle | 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 Hospital volume and outcomes of surgical repair in type A acute aortic dissection: A nationwide cohort study. PLoS ONE |
| title | Hospital volume and outcomes of surgical repair in type A acute aortic dissection: A nationwide cohort study. |
| title_full | Hospital volume and outcomes of surgical repair in type A acute aortic dissection: A nationwide cohort study. |
| title_fullStr | Hospital volume and outcomes of surgical repair in type A acute aortic dissection: A nationwide cohort study. |
| title_full_unstemmed | Hospital volume and outcomes of surgical repair in type A acute aortic dissection: A nationwide cohort study. |
| title_short | Hospital volume and outcomes of surgical repair in type A acute aortic dissection: A nationwide cohort study. |
| title_sort | hospital volume and outcomes of surgical repair in type a acute aortic dissection a nationwide cohort study |
| url | https://doi.org/10.1371/journal.pone.0325689 |
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