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Published on: March 26, 2018
Elective thoracic aortic aneurysm surgery: better outcomes from high-volume centers
Leo M Gazoni1, Alan M Speir, Irving L Kron
1Department of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, VA 22908, USA.
Journal of the American College of Surgeons
|April 28, 2010
Summary
High-volume centers significantly improve thoracic aortic aneurysm repair outcomes, reducing mortality and costs. While lower-volume centers had fewer strokes, high-volume centers demonstrated superior overall results.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Surgical Outcomes
Background:
- Previous studies show clinical benefits of high-volume (HV) centers for esophageal and pancreatic resections.
- Outcomes for thoracic aortic aneurysm repair at HV centers versus lower-volume (LV) centers remain understudied.
Purpose of the Study:
- To determine if HV centers achieve better outcomes for thoracic aortic aneurysm surgery compared to LV centers.
- To analyze the impact of center volume on mortality and complications in elective thoracic aortic aneurysm repair.
Main Methods:
- Retrospective review of prospectively collected data from 17 institutions in the Virginia Cardiac Surgery Quality Initiative (VCSQI) database.
- Defined LV centers as performing <40 operations and HV centers as performing >80 operations during the 3-year study period.
- Compared preoperative risk factors and outcomes, including mortality, renal failure, prolonged ventilation, stroke, and hospital cost, using multivariate analysis.
Main Results:
- HV centers performed 515 operations; LV centers performed 216.
- Perioperative mortality was significantly lower in HV centers (3.7%) vs. LV centers (8.3%) (p=0.02).
- HV centers showed lower rates of renal failure (4.5% vs. 8.3%, p=0.05) and prolonged ventilator course (16.7% vs. 25.5%, p=0.01), but higher stroke rates (4.8% vs. 1.4%, p<0.01). Total hospital cost was lower in HV centers ($42,736 vs. $51,296, p=0.04).
Conclusions:
- HV centers demonstrated better overall outcomes, lower mortality rates, and reduced costs for thoracic aortic aneurysm repair compared to LV centers.
- Despite a higher stroke rate, the overall benefits of HV centers suggest a volume-outcome relationship in this surgical domain.
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