Acute type A aortic dissection in the United Kingdom: Surgeon volume-outcome relation

作者：Bashir Mohamad^*; Harky Amer; Fok Matthew; Shaw Matthew; Hickey Graeme L; Grant Stuart W; Uppal Rakesh; Oo Aung

来源：The Journal of Thoracic and Cardiovascular Surgery, 2017, 154(2): 398-+.

DOI：10.1016/j.jtcvs.2017.02.015

• aorta
• dissection
• aneurysm
• surgeon volume-outcome
• AAD

Objectives: Surgery for acute type A aortic dissection (ATAD) carries a high risk of operative mortality. We examined the surgeon volume-outcome relation with respect to in-hospital mortality for patients presenting with this pathology in the United Kingdom.
Method: Between April 2007 and March 2013, 1550 ATAD procedures were identified from the National Institute for Cardiovascular Outcomes Research database. A total of 249 responsible consultant cardiac surgeons from the United Kingdom recorded 1 or more of these procedures in their surgical activity over this period. We describe the patient population and mortality rates, focusing on the relationship between surgeon volume and in-hospital mortality.
Results: The mean annual volume of procedures per surgeon during the 6-year period ranged from 1 to 6.6. The overall in-hospital mortality rate was 18.3% (283/1550). A mortality improvement at the 95% level was observed with a risk-adjusted mean annual volume >4.5. Surgeons with a mean annual volume <4 over the study period had significantly higher in-hospital mortality rates in comparison with surgeons with a mean annual volume >= 4 (19.3% vs 12.6%; P = .015).
Conclusions: Patients with ATAD who are operated on by lower-volume surgeons experience higher levels of in-hospital mortality. Directing these patients to higher-volume surgeons may be a strategy to reduce in-hospital mortality.

• 出版日期2017-8