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Volume-failure-to-rescue relationship in acute type A aortic dissections: An analysis of The Society of Thoracic Surgeons Database
Abstract
Objective To determine the relationship between volume of cases and failure-to-rescue (FTR) rate after surgery for acute type A aortic dissection (ATAAD) across the United States. Methods The Society of Thoracic Surgeons adult cardiac surgery database was used to review outcomes of surgery after ATAAD between June 2017 and December 2021. Mixed-effect models and restricted cubic splines were used to determine the risk-adjusted relationships between ATAAD average volume and FTR rate. FTR calculation was based on deaths associated with the following complications: venous thromboembolism/deep venous thrombosis, stroke, renal failure, mechanical ventilation >48 hours, sepsis, gastrointestinal complications, cardiopulmonary resuscitation, and unplanned reoperation. Results In total, 18,192 patients underwent surgery for ATAAD in 832 centers. The included hospitals' median volume was 2.2 cases/year (interquartile range [IQR], 0.9-5.8). Quartiles' distribution was 615 centers in the first (1.3 cases/year, IQR, 0.4-2.9); 123 centers in the second (8 cases/year, IQR, 6.7-10.2); 66 centers in the third (15.6 cases/year, IQR, 14.2-18); and 28 centers in the fourth quartile (29.3 cases/year, IQR, 28.8-46.0). Fourth-quartile hospitals performed more extensive procedures. Overall complication, mortality, and FTR rates were 52.6%, 14.2%, and 21.7%, respectively. Risk-adjusted analysis demonstrated increased odds of FTR when the average volume was fewer than 10 cases per year. Conclusions Although high-volume centers performed more complex procedures than low-volume centers, their operative mortality was lower, perhaps reflecting their ability to rescue patients and mitigate complications. An average of fewer than 10 cases per year at an institution is associated with increased odds of failure to rescue patients after ATAAD repair.
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Metadata
- Authors
- Diaz-Castrillon, C. E., Serna-Gallegos, D., Arnaoutakis, G., Grimm, J., Szeto, W. Y., Chu, D., Sezer, A., & Sultan, I.
- Affiliations
- University of Pittsburgh Medical Center (US)
- The University of Texas at Austin (US)
- University of Pennsylvania (US)
- Corresponding author
- Sultan, Ibrahim
- ORCID
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2024-11
- Volume
- 168
- Issue
- 5
- Pages
- 1416-1425.e7
- ISSN
- 0022-5223 (ISSN-L)
- OpenAlex
- W4386283520
- Cited by
- 20
- References
- 30
- Citations by year
- 2026: 9 · 2025: 7 · 2024: 3
- FWCI
- 3.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Society of Thoracic Surgeons
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Aortic Disease and Treatment Approaches
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Connective tissue disorders research
- Keywords
- acute type A aortic dissection, failure to rescue, surgical volume, volume-outcome relationship, aortic surgery, postoperative complications, postoperative mortality, high-volume centers, Society of Thoracic Surgeons database
- MeSH terms
- Failure to Rescue, Health Care, Acute Disease, Aged, Aortic Dissection, Female, Humans, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Risk Factors, Time Factors, United States, Vascular Surgical Procedures, Databases, Factual, Treatment Outcome, Aortic Aneurysm, Thoracic, Risk Assessment, Hospitals, Low-Volume, Hospitals, High-Volume
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