The impact of institutional case volume on the prognosis of ruptured aortic aneurysms: a Japanese nationwide study

• Published in: Interactive cardiovascular and thoracic surgery 2019-07, Vol.29 (1), p.109-116
• Main Authors: Yamaguchi, Tetsuo, Nakai, Michikazu, Sumita, Yoko, Nishimura, Kunihiro, Miyamoto, Takamichi, Sakata, Yasushi, Nozato, Toshihiro, Ogino, Hitoshi
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal - diagnosis; Aortic Aneurysm, Abdominal - epidemiology; Aortic Aneurysm, Abdominal - surgery; Aortic Rupture - diagnosis; Aortic Rupture - epidemiology; Aortic Rupture - surgery; Databases, Factual; Female; Hospital Mortality - trends; Humans; Incidence; Japan - epidemiology; Male; Odds Ratio; Patient Discharge - trends; Prognosis; Registries; Time Factors; Treatment Outcome
• ISSN: 1569-9285; 1569-9285
• DOI: 10.1093/icvts/ivz023

To improve outcome for ruptured aortic aneurysms (rAAs), centralization of treatment is potentially effective. However, there is no nationwide survey for the current managements and outcomes of rAA in Japan. The aim of this study was to assess the volume-outcome relationship for rAA treatment using the nationwide claim-based database. Using the Japanese Registry of All cardiac and vascular Diseases-Diagnostic Procedure Combination database, we identified patients admitted to 564 certified teaching hospitals with rAA between 1 April 2012 and 31 March 2015. Institutional case volume (cardiovascular surgeries per year) was categorized into quartiles (lowest, low, high and highest), and the odds ratios (ORs) for in-hospital mortality and neurological status at discharge were analysed for each quartile. Of 7086 eligible patients, 3925 (55.4%) died in hospital. Mortality rates decreased from 69.4% in the lowest volume to 43.8% in the highest volume category (P