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Costs and Readmissions Associated with Type A Aortic Dissections at High- and Low-Volume Centers

Alice L Zhou1, Lekha V Yesantharao2, Eric W Etchill3

  • 1Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. azhou18@jhmi.edu.

The Heart Surgery Forum
|January 5, 2024
PubMed

Insights

High-volume centers for type A aortic dissection repair admit more transferred patients and incur higher initial costs, but demonstrate similar mortality and readmission rates compared to low-volume centers.

Area of Science:

  • Cardiovascular Surgery
  • Health Services Research
  • Thoracic Surgery

Background:

  • Surgical repair of type A aortic dissection is complex, with outcomes and costs at varying center volumes not fully understood.
  • Understanding resource utilization and patient outcomes is crucial for optimizing care delivery for this critical condition.

Purpose of the Study:

  • To investigate and compare statewide readmissions, costs, and patient outcomes for type A aortic dissection repairs performed at high-volume versus low-volume centers.
  • To analyze the impact of patient transfer status on outcomes and resource utilization within high-volume centers.

Main Methods:

  • A retrospective analysis of adult patients undergoing operative repair for type A aortic dissection was conducted using the Maryland Health Services Cost Review Commission database (2012-2020).
  • Hospitals were categorized into high-volume (top quartile of repairs) and low-volume centers.
  • Patient demographics, severity of illness, transfer status, length of stay, mortality, costs, and readmission rates were analyzed.

Main Results:

  • Of 249 patients, 77.5% were treated at high-volume centers, which admitted a greater proportion of transferred patients (71.5% vs. 17.9%).
  • High-volume centers had longer lengths of stay (12 vs. 8 days) and significantly higher index admission costs ($114,859 vs. $72,090), with no difference in inpatient mortality (13.0% vs. 16.1%) or readmission rates (54.9% vs. 51.8%).
  • Transferred patients at high-volume centers exhibited greater illness severity and resource utilization, but similar mortality and lengths of stay compared to direct admissions.

Conclusions:

  • High-volume centers manage a larger volume of transferred type A aortic dissection patients, associated with increased initial resource utilization and costs.
  • Despite higher initial resource demands, high-volume centers achieve comparable inpatient mortality and readmission rates to low-volume centers.
  • Transfer patients to high-volume centers present with higher illness severity and resource needs, yet experience similar outcomes to direct admissions.
Abstract

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