Hospital volume and outcomes of surgical repair in type A acute aortic dissection: A nationwide cohort study

Abstract

Background Over the last decade, the number of patients treated with open repair for TAAAD in Taiwan has dramatically increased. This study aims to assess the hospital-volume relationship with surgical outcomes of type A acute aortic dissection (TAAAD) across hospitals in Taiwan. Methods Using the Taiwan National Health Insurance (NHI) Research Database (NHIRD), we include only the patients who underwent first open repair for TAAAD from 01/01/2005, to 31/12/2020, in Taiwan. A total of 8,059 patients in 77 hospitals were eligible for the analysis. Hospitals were categorized based on their 16-year cumulative volume of TAAAD open repair surgeries, and patients were grouped into quartiles accordingly. Results Ascending aortic replacement (55.7%) and partial/total arch replacement (38.8%) were the most common methods of open aortic repair. In-hospital mortality was 22% and decreased from 28% in 2005 to 20% in 2020. Greater volume (per 5 annual surgeries) was associated with lower risks of in-hospital mortality (odd ratio 0.90, 95% confidence interval [CI] 0.87–0.92) and mortality after discharge (hazard ratio 0.97, 95% CI 0.95–0.99). Conclusion Operative volume inversely correlates to in-hospital mortality and postoperative complications. The volume-outcome effect extends after discharge and reflects better long-term survival. Hospital referral to high-volume centers should be considered in patients needing complex open repair for TAAAD.