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Published on: March 26, 2018
Higher Institutional Volume Reduces Mortality in Reoperative Proximal Thoracic Aortic Surgery
Nicholas J Shea1, Alex M D'Angelo1, Antonio R Polanco1
1Department of Surgery, New York-Presbyterian Hospital, Columbia University Aortic Surgery Center, Columbia University Irving Medical Center, New York, New York.
Objective:
This study aims to determine the impact of institutional volume on mortality in reoperative proximal thoracic aortic surgery patients using national outcomes data.
Methods:
The Nationwide Inpatient Sample was queried from 1998 to 2011 for patients with diagnoses of thoracic aneurysm and/or dissection who underwent open mediastinal repair. A total of 103,860 patients were identified. A total of 1,430 patients had prior cardiac surgery. Patients were further stratified into groups by institutional aortic volume: low (<12 cases/year), medium (12-39 cases/year), and high (40+ cases/year) volume. Multivariable risk-adjusted analysis accounting for emergent status and aortic dissection among other factors was performed to determine the impact of institutional volume on mortality.
Results:
Overall mortality was 12% in the reoperative population. When the redo cohort was divided into tertiles, high-volume group had a 5% operative mortality compared with 9 and 15% for the medium- and low-volume groups, respectively. Multivariable analysis revealed that patients operated on at low- (odds ratio [OR] = 5.0, 95% confidence interval [CI]: 2.6-9.6, p < 0.001) and medium-volume centers (OR = 2.1, 95% CI: 1.1-4.2, p = 0.03) had higher odds of mortality when compared with patients operated on at high-volume centers.
Conclusions:
High-volume aortic centers can significantly reduce mortality for reoperative aortic surgery, compared with lower volume institutions.
