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Acute Type A Dissection Repair by High-Volume Vs Low-Volume Surgeons at a High-Volume Aortic Center
- Source :
- J Thorac Dis
- Publication Year :
- 2018
-
Abstract
- Background Previous studies suggest improved outcomes for acute type A dissections (ATAAD) treated at high-volume centers. It is unclear if outcomes are a result of individual surgeon experience or inherent resources available at high-volume centers. To explore this question, we stratified outcomes for ATAAD repair by low-volume and high-volume surgeons at a high-volume center. Methods We reviewed our institutional experience with ATAAD between 1999 and 2016 (n = 580). To evaluate surgeon experience with ATAAD repair, we categorized surgeons as high-volume aortic surgeons (HVASs) (> 10 cases/year) or low-volume aortic surgeons (LVASs) (≤ 10 cases/year). Analysis was stratified according to the following: HVAS in primary and first assist roles, HVAS as primary with LVAS as first assist, LVAS as primary and HVAS as first assist, and LVAS in both roles. Results The total experience for HVAS and LVAS as primary surgeon for the study period was 513 and 67, respectively. Mean annual experience as primary surgeon was 15.2 cases for HVAS and 3.4 cases for LVAS. In-hospital mortality was 14.0% if an HVAS was present and 24.0% with an all-LVAS team (P = .27). After adjusting for preoperative factors, the mortality odds ratio (OR) for an all-LVAS team was 3.72 (P = .01). Conclusions ATAAD repair by an all-LVAS team had nearly a 4-fold increase in-hospital mortality compared with an all-HVAS team. Improved outcomes at high-volume centers may be predominantly due to surgeon experience and not from center-specific resources. This study may have implications on call coverage for ATAAD repair at high-volume centers.
- Subjects :
- Pulmonary and Respiratory Medicine
Adult
Male
medicine.medical_specialty
Treatment outcome
030204 cardiovascular system & hematology
03 medical and health sciences
0302 clinical medicine
Aneurysm
Medicine
Humans
Hospital Mortality
Aged
Retrospective Studies
business.industry
General surgery
Retrospective cohort study
Odds ratio
Middle Aged
medicine.disease
Low volume
Dissection
Aortic Dissection
Editorial Commentary
Treatment Outcome
030228 respiratory system
Acute type
Acute Disease
Surgery
Female
Clinical Competence
Clinical competence
Cardiology and Cardiovascular Medicine
business
Vascular Surgical Procedures
Hospitals, High-Volume
Subjects
Details
- ISSN :
- 15526259
- Volume :
- 108
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- The Annals of thoracic surgery
- Accession number :
- edsair.doi.dedup.....43236b4009316e41b09295b04f5a4892