Transportation model for acute aortic dissection: implications for reduced treatment centres

Area of Science:

• Cardiovascular Surgery
• Health Services Research
• Medical Economics

Background:

• Acute type A aortic dissection requires timely surgical intervention.
• Centralizing care in high-volume centers can improve outcomes.
• The impact of reduced treatment centers on access and outcomes in Germany is not fully understood.

Purpose of the Study:

• To model the effects of fewer treatment centers for acute type A aortic dissection on preclinical transportation.
• To assess the implementability of centralized treatment in Germany regarding treatment time.
• To evaluate the relationship between center volume and in-hospital mortality.

Main Methods:

• Utilized data from German cardiac surgery centers (n=76) and national statistics (2005-2015).
• Modeled transportation distances and times using Google Maps for patient transfers.
• Analyzed in-hospital mortality rates in relation to mean annual center volume for acute type A aortic dissection (n=14,102).

Main Results:

• A median transportation distance of 27.13 km and time of 35.78 min was observed with 76 centers.
• Reducing centers to 12 could be feasible with a doubled transportation time (70 min).
• Higher annual volumes (>25-30) were significantly associated with lower in-hospital mortality (P < 0.001).

Conclusions:

• Centralizing acute type A aortic dissection care in fewer, high-volume centers improves survival rates.
• The benefits of reduced mortality outweigh the extended transportation times.
• Implementing a volume-outcome relationship is crucial for optimizing care delivery.