Interinstitutional analysis of the outcome after surgery for type A aortic dissection

Abstract

Purpose To evaluate the impact of individual institutions on the outcome after surgery for Stanford type A aortic dissection (TAAD). 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.

Lactate-Based Difference as a Determinant of Outcomes following Surgery for Type A Acute Aortic Dissection: A Multi-Centre Study

“…The registry prospectively gathers demographic information, along with pre-and postoperative clinical data, encompassing mortality, for all TAAAD procedures carried out in three adult cardiac surgery centres in France and Italy. Previous reports have detailed the flow of data from input by surgeons to analysis, including different surgical approaches [7,[23][24][25]. To summarise, the data were inputted locally and checked at the unit level by database managers before being uploaded to a single database for analysis.…”

“…In our analysis, we noted that arterial lactate levels were elevated in cases of renal malperfusion (p = 0.009) along with cardiac tamponade (p < 0.0001), cardiogenic shock (p = 0.05), LVEF (p = 0.014), and priority urgency procedures (salvage 1 p = 0.05; urgent p = 0.0001). Therefore, after determining preoperative risks, a meticulous clinical examination, as well as surgical centre proficiency, becomes particularly crucial in high-risk cases [8,24,38].…”

Preoperative Imaging Signs of Cerebral Malperfusion in Acute Type A Aortic Dissection: Influence on Outcomes and Prognostic Implications—A 20-Year Experience

“…The patients without PSCM underwent more Bentall surgeries (8.5% vs. 22.4%; p = 0.004) and had more aortic valve replacements (6.1% vs. 21.6%; p = 0.001). The patients presenting with PSCM received more intraoperative packed red blood cells (4 units, IQR [2,6] vs. 2 units, IQR [0, 5]; p < 0.001), fresh frozen plasma (3 units, IQR [0, 6] vs. 0 units, IQR [0, 4]; p = 0.003), and platelets (2 units, IQR [1,2] vs. 2 units, IQR [1,2]; p = 0.035). There were no significant differences observed in the choice of arterial or venous cannulation sites between both groups.…”

“…Despite the ongoing advancements in the diagnosis and expedited management of ATAAD, the early mortality rates remain alarmingly high. In contemporary practice, the in-hospital mortality rate for ATAAD patients who undergo surgery ranges between 10 and 18% with considerable between-hospital variations [1][2][3][4][5].…”