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Improved outcomes of endovascular repair of thoracic aortic injuries at higher volume institutions
- Source :
- Journal of vascular surgery. 73(4)
- Publication Year :
- 2020
-
Abstract
- Background The use of thoracic endovascular aortic repair (TEVAR) has significantly improved the ability to treat traumatic aortic injuries (tTEVAR). We sought to determine whether a greater center volume correlated with better outcomes. Methods Vascular Quality Initiative data of TEVAR (2011-2017) for trauma were used in the present analysis. Using the distribution of the annual case volume at the participating centers, the sample was stratified into three terciles. In-hospital mortality at high-volume centers (HVCs) and low-volume centers (LVCs) was compared after adjustment for risk factors established in our previous Vascular Quality Initiative-based risk model containing age, gender, renal impairment, left subclavian artery involvement, and select concomitant injuries. Results A total of 619 tTEVAR cases were studied across 74 centers. HVCs (n = 184 cases) had performed ≥4.9 cases annually and LVCs (n = 220 cases) had performed ≤2.4 cases annually. Both crude mortality (4.4% vs 8.6%; P = .22) and adjusted odds of mortality (odds ratio, 0.44; 95% confidence interval, 0.18-1.09; P = .08) showed a trend toward better outcomes for tTEVAR performed at HVCs than at LVCs. The addition of center volume to our previous multivariate model significantly improved its discriminative ability (C-statistic, 0.90 vs 0.88; P = .02). The overall TEVAR volume (for all indications) was not associated with increased odds of mortality for tTEVAR (odds ratio, 0.46; 95% confidence interval, 0.17-1.20; P = .11), nor did it improve the model's discriminative ability. Conclusions Higher volume centers showed improved perioperative mortality after tTEVAR. The thoracic aortic trauma volume was more predictive than the overall TEVAR volume, suggesting that technical expertise is not the driving factor. Stable patients might benefit from transfer to a higher volume center before repair.
- Subjects :
- Adult
Male
medicine.medical_specialty
Hospitals, Low-Volume
Time Factors
Aorta, Thoracic
030204 cardiovascular system & hematology
Aortic repair
Wounds, Nonpenetrating
Risk Assessment
Odds
03 medical and health sciences
Blood Vessel Prosthesis Implantation
Young Adult
0302 clinical medicine
Risk Factors
Internal medicine
medicine
Humans
030212 general & internal medicine
Hospital Mortality
Registries
Quality Indicators, Health Care
Retrospective Studies
Case volume
business.industry
Endovascular Procedures
Odds ratio
Perioperative
Middle Aged
Vascular System Injuries
Quality Improvement
Confidence interval
United States
Outcome and Process Assessment, Health Care
Treatment Outcome
Concomitant
Cardiology
Surgery
Female
Cardiology and Cardiovascular Medicine
business
Hospitals, High-Volume
Volume (compression)
Subjects
Details
- ISSN :
- 10976809 and 20112017
- Volume :
- 73
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Journal of vascular surgery
- Accession number :
- edsair.doi.dedup.....53ab317d0393cb293a7d285b4b4bd0ef