Improving mortality trends for hospitalization of aortic dissection in the National Inpatient Sample

Zimmerman, Kate; Oderich, Gustavo S.; Pochettino, Alberto; Hanson, Kristine T.; Habermann, Elizabeth B.; Bower, Thomas C.; Gloviczki, Péter; DeMartino, Randall R.

doi:10.1016/j.jvs.2016.03.427

Cited by 43 publications

(33 citation statements)

References 30 publications

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“…It is clear that at least some of the impact on improving survival is related to these factors (18, 19). The overall operative mortality rate of 18.9% in this cohort, is consistent with the current literature (6–9, 16–18, 20–22). Mody et al demonstrated significant improvement in 30-day mortality for Medicare patients from 30.7% in 2000 to 21.4% in 2011, similar to an IRAD analysis where in-hospital mortality decreased from 25.0% in an era starting in 1996 to 18.4% currently (7, 8).…”

Section: Commentsupporting

confidence: 92%

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Regional Practice Patterns and Outcomes of Surgery for Acute Type A Aortic Dissection

Hawkins

Mehaffey

Downs

et al. 2017

The Annals of Thoracic Surgery

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Background The surgical management of acute Type A aortic dissection is evolving and many aortic centers of excellence are reporting superior outcomes. We hypothesize that similar trends exist in a multi-institutional regional consortium. Methods Records for 884 consecutive patients who underwent aortic operations (2003 to 2015) for acute Type A aortic dissection were extracted from a regional Society of Thoracic Surgeons database. Patients were stratified into three equal operative eras. Differences in outcomes and risk factors for morbidity and mortality were determined. Results Surgery for Type A aortic dissection is increasing in extent and complexity. Aortic root repair was performed in 16% of early era cases compared to 67% currently (p<0.0001). Similarly, aortic arch repair increased from 27% to 37% cases (p<0.0001). Cerebral perfusion is currently utilized in 85% of circulatory arrest cases, most frequently antegrade (57%). Total circulatory arrest times increased (29 vs 31 vs 36 min, p=0.005), but times without cerebral perfusion were stable (12 vs 6 min, p=0.68). While operative mortality remained stable at 18.9% during the 3 operative eras, there were significant decreases in pneumonia and reoperations (p<0.05). Predictors of operative mortality and major morbidity are age (OR=1.04; p<0.0001), prior stroke (OR=2.09; p=0.03), and elevated creatinine (OR 1.31, p=0.01). Importantly, extent of aortic operation did not increase risk for morbidity or mortality. Conclusions Operative morbidity and mortality remains significant for Type A aortic dissection, but lower than historical outcomes. Extent of aortic surgery has increased resulting in adaptive cerebral protection changes in contemporary “real-world” practice.

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Section: Commentsupporting

confidence: 92%

“…Many centers of excellence report improved rates of survival in patients undergoing surgical repair of TAAD over the past two decades (6, 7). These improvements have been due to an evolution in approaches, cannulation strategies, cerebral perfusion, and temperature management (8–10).…”

mentioning

confidence: 99%

Regional Practice Patterns and Outcomes of Surgery for Acute Type A Aortic Dissection

Hawkins

Mehaffey

Downs

et al. 2017

The Annals of Thoracic Surgery

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“…First, owing the emergent nature of AAS, no randomized trials of abdominal aortic aneurysm interventions were retrieved, therefore limiting our qualitative and quantitative analysis to retrospective observational studies only, often with a limited sample size. 21–50 Retrospective studies are subject to confounders and bias, possibly resulting in a decline in the power of our meta-analysis. The majority of collected data were derived from a simple univariate comparison analysis, therefore limiting the opportunity to perform sub-group analysis, especially with reference to the different entities included in the wide definition of AAS.…”

Section: Limitationsmentioning

confidence: 99%

Aortic centres should represent the standard of care for acute aortic syndrome

Mariscalco

Maselli

Zanobini

et al. 2018

Eur J Prev Cardiolog

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Background Existing evidence suggests that patients affected by acute aortic syndromes (AAS) may benefit from treatment at dedicated specialized aortic centres. The purpose of the present study was to perform a meta-analysis to evaluate the impact aortic service configuration has in clinical outcomes in AAS patients. Methods The design was a quantitative and qualitative review of observational studies. We searched PubMed/ MEDLINE, EMBASE, and Cochrane Library from inception to the end of December 2017 to identify eligible articles. Areas of interest included hospital and surgeon volume activity, presence of a multidisciplinary thoracic aortic surgery program, and a dedicated on-call aortic team. Participants were patients undergoing repair for AAS, and odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were adopted for synthesizing hospital/30-day mortality. Results A total of 79,131 adult patients from a total of 30 studies were obtained. No randomized studies were identified. Pooled unadjusted ORs showed that patients treated in high-volume centres or by high-volume surgeons were associated with lower mortality rates (OR 0.51; 95% CI 0.46-0.56, and OR 0.41, 95% CI 0.25-0.66, respectively). Pooled adjusted estimates for both high-volume centres and surgeons confirmed these survival benefits (adjusted OR, 0.56; 95% CI 0.45-0.70, respectively). Patients treated in centres that introduced a specific multidisciplinary aortic program and a dedicated on-call aortic team also showed a significant reduction in mortality (OR 0.31; 95% CI 0.19-0.5, and OR 0.37; 95% CI 0.15-0.87, respectively). Conclusions We found that specialist aortic care improves outcomes and decreases mortality in patients affected by AAS.

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“…Com uma apresentação clínica que abrange desde o indolente e provavelmente benigno (pequeno aneurisma aórtico) ao emergente e com risco de vida (dissecção aórtica). Por isso, a alocação adequada de recursos de serviços de saúde para garantir atendimento de qualidade ao paciente torna-se um desafio (MODY et al, 2014;PAPE et al, 2015;ZIMMERMAN et al, 2016).…”

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Manejo de pacientes com aneurisma de aorta torácica: uma revisão bibliográfica/Management of patients with thoracic aortic aneurysm: a literature review

Mendonça

Alves

Borges

2020

BJHR

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Improving mortality trends for hospitalization of aortic dissection in the National Inpatient Sample

Cited by 43 publications

References 30 publications

Regional Practice Patterns and Outcomes of Surgery for Acute Type A Aortic Dissection

Regional Practice Patterns and Outcomes of Surgery for Acute Type A Aortic Dissection

Aortic centres should represent the standard of care for acute aortic syndrome

Manejo de pacientes com aneurisma de aorta torácica: uma revisão bibliográfica/Management of patients with thoracic aortic aneurysm: a literature review

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