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Increased Hospital Volume Is Associated with Reduced Mortality After Thoracoabdominal Aortic Aneurysm Repair
ABSTRACTObjectivesContemporary data on outcomes in open thoracoabdominal aortic aneurysm (TAAA) repair is limited to reports from major aortic referral centers showing excellent outcomes. This study aims to characterize the national experience of open TAAA repair using national outcomes data, with a...
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| Published in: | Journal of vascular surgery 2021-02, Vol.73 (2), p.451-458 |
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| container_title | Journal of vascular surgery |
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| creator | Polanco, Antonio R., MD D’Angelo, Alex M., MD Shea, Nicholas J., MD, MS Allen, Philip, BS Takayama, Hiroo, MD, PhD Patel, Virendra I., MD, MPH |
| description | ABSTRACTObjectivesContemporary data on outcomes in open thoracoabdominal aortic aneurysm (TAAA) repair is limited to reports from major aortic referral centers showing excellent outcomes. This study aims to characterize the national experience of open TAAA repair using national outcomes data, with a primary focus to examine the association of hospital volume with mortality and morbidity. MethodsThe Nationwide Inpatient Sample was queried from 1998-2011 and all patients with a diagnosis of TAAA who underwent open operative repair were included. These patients were further stratified into tertiles based on the operative volume of the institution that performed their operation: low volume (LV, |
| doi_str_mv | 10.1016/j.jvs.2020.05.027 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2408196819</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0741521420312829</els_id><sourcerecordid>2408196819</sourcerecordid><originalsourceid>FETCH-LOGICAL-c451t-b42fabb11d11a34482f45b2bc55a6dbee6de8384c3c7d7bf0406f03b85a2c6ce3</originalsourceid><addsrcrecordid>eNp9kU1v1DAQhi0EokvhB3BBOXJJGH_kY4WEFFVAVyqqVApXy3YmqkMSL56k1f57vNrCgUMPlmX5eV9pnmHsLYeCA68-DMVwT4UAAQWUBYj6Gdtw2NZ51cD2OdtArXheCq7O2CuiAYDzsqlfsjMpVC2lgg0bd7OLaAi77DLQ3i9mzH6GcZ0w21HWEgXnzZJ-H_xyl91gt7r0-BZiAv1yyNp-wZjd3oVoXDC2C5OfU0WbAO-ydsY1HmhKwb3x8TV70ZuR8M3jfc5-fPl8e3GZX11_3V20V7lTJV9yq0RvrOW849xIpRrRq9IK68rSVJ1FrDpsZKOcdHVX2x4UVD1I25RGuMqhPGfvT737GH6vSIuePDkcRzNjWEkLBQ3fVukklJ9QFwNRxF7vo59MPGgO-ihZDzpJ1kfJGkqdJKfMu8f61U7Y_Uv8tZqAjycA05D3HqMm53FO5nxEt-gu-CfrP_2XdqOfvTPjLzwgDWGNSTFprklo0N-PWz4uWYDkohFb-QcAb6N7</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2408196819</pqid></control><display><type>article</type><title>Increased Hospital Volume Is Associated with Reduced Mortality After Thoracoabdominal Aortic Aneurysm Repair</title><source>BACON - Elsevier - GLOBAL_SCIENCEDIRECT-OPENACCESS</source><creator>Polanco, Antonio R., MD ; D’Angelo, Alex M., MD ; Shea, Nicholas J., MD, MS ; Allen, Philip, BS ; Takayama, Hiroo, MD, PhD ; Patel, Virendra I., MD, MPH</creator><creatorcontrib>Polanco, Antonio R., MD ; D’Angelo, Alex M., MD ; Shea, Nicholas J., MD, MS ; Allen, Philip, BS ; Takayama, Hiroo, MD, PhD ; Patel, Virendra I., MD, MPH</creatorcontrib><description><![CDATA[ABSTRACTObjectivesContemporary data on outcomes in open thoracoabdominal aortic aneurysm (TAAA) repair is limited to reports from major aortic referral centers showing excellent outcomes. This study aims to characterize the national experience of open TAAA repair using national outcomes data, with a primary focus to examine the association of hospital volume with mortality and morbidity. MethodsThe Nationwide Inpatient Sample was queried from 1998-2011 and all patients with a diagnosis of TAAA who underwent open operative repair were included. These patients were further stratified into tertiles based on the operative volume of the institution that performed their operation: low volume (LV, <3 cases/year), medium volume (MV, 3-11 cases/year), high volume (HV, ≥12 cases/year). Baseline demographics as well as perioperative outcomes were compared between these groups. Multivariable logistic regression was performed to determine predictors of operative mortality and morbidity. Subgroup analyses were performed for patients presenting for elective surgery (ESC) and for those presenting for urgent and emergent surgery (UEC). ResultsOverall operative mortality was 21% for the entire cohort. Operative mortality was higher at LV (26%) and MV (21%) centers compared to HV centers (15%) (p<0.001). This difference was similar in both the ESC (LV 18% and MV 14% vs HV 12%, p<0.001) as well as the UEC (LV 34% and MV 30% vs HV 19%, p<0.001). Further, rates of blood transfusion as well as acute renal failure were significantly lower in the HV group. Multivariable analysis revealed that, compared to the HV group, patients operated on at LV centers (OR 1.9, 95% CI 1.7-2.1, p<0.001) and MV centers (OR 1.5, 95% CI 1.4-1.7, p<0.001) had at least 1.5x the odds of in-hospital mortality. The HV group also has significantly lower odds of dying in the subgroup analyses of both the ESC and the UEC. Increasing TAAA volume was associated with increased use of distal aortic perfusion (OR 1.03, 95% CI 1.02 – 1.03, p<0.001). ConclusionsPatients with TAAA in the United States operated on at HV centers have significantly lower mortality and morbidity compared to lower volume centers. Consideration of referral to HV centers may be warranted, but further research is required to justify this conclusion.]]></description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2020.05.027</identifier><identifier>PMID: 32473340</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aortic repair ; Mortality ; Surgery ; Thoracoabdominal aortic aneurysm</subject><ispartof>Journal of vascular surgery, 2021-02, Vol.73 (2), p.451-458</ispartof><rights>2020 Society for Vascular Surgery</rights><rights>Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c451t-b42fabb11d11a34482f45b2bc55a6dbee6de8384c3c7d7bf0406f03b85a2c6ce3</citedby><cites>FETCH-LOGICAL-c451t-b42fabb11d11a34482f45b2bc55a6dbee6de8384c3c7d7bf0406f03b85a2c6ce3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27898,27899</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32473340$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Polanco, Antonio R., MD</creatorcontrib><creatorcontrib>D’Angelo, Alex M., MD</creatorcontrib><creatorcontrib>Shea, Nicholas J., MD, MS</creatorcontrib><creatorcontrib>Allen, Philip, BS</creatorcontrib><creatorcontrib>Takayama, Hiroo, MD, PhD</creatorcontrib><creatorcontrib>Patel, Virendra I., MD, MPH</creatorcontrib><title>Increased Hospital Volume Is Associated with Reduced Mortality After Thoracoabdominal Aortic Aneurysm Repair</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description><![CDATA[ABSTRACTObjectivesContemporary data on outcomes in open thoracoabdominal aortic aneurysm (TAAA) repair is limited to reports from major aortic referral centers showing excellent outcomes. This study aims to characterize the national experience of open TAAA repair using national outcomes data, with a primary focus to examine the association of hospital volume with mortality and morbidity. MethodsThe Nationwide Inpatient Sample was queried from 1998-2011 and all patients with a diagnosis of TAAA who underwent open operative repair were included. These patients were further stratified into tertiles based on the operative volume of the institution that performed their operation: low volume (LV, <3 cases/year), medium volume (MV, 3-11 cases/year), high volume (HV, ≥12 cases/year). Baseline demographics as well as perioperative outcomes were compared between these groups. Multivariable logistic regression was performed to determine predictors of operative mortality and morbidity. Subgroup analyses were performed for patients presenting for elective surgery (ESC) and for those presenting for urgent and emergent surgery (UEC). ResultsOverall operative mortality was 21% for the entire cohort. Operative mortality was higher at LV (26%) and MV (21%) centers compared to HV centers (15%) (p<0.001). This difference was similar in both the ESC (LV 18% and MV 14% vs HV 12%, p<0.001) as well as the UEC (LV 34% and MV 30% vs HV 19%, p<0.001). Further, rates of blood transfusion as well as acute renal failure were significantly lower in the HV group. Multivariable analysis revealed that, compared to the HV group, patients operated on at LV centers (OR 1.9, 95% CI 1.7-2.1, p<0.001) and MV centers (OR 1.5, 95% CI 1.4-1.7, p<0.001) had at least 1.5x the odds of in-hospital mortality. The HV group also has significantly lower odds of dying in the subgroup analyses of both the ESC and the UEC. Increasing TAAA volume was associated with increased use of distal aortic perfusion (OR 1.03, 95% CI 1.02 – 1.03, p<0.001). ConclusionsPatients with TAAA in the United States operated on at HV centers have significantly lower mortality and morbidity compared to lower volume centers. Consideration of referral to HV centers may be warranted, but further research is required to justify this conclusion.]]></description><subject>Aortic repair</subject><subject>Mortality</subject><subject>Surgery</subject><subject>Thoracoabdominal aortic aneurysm</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kU1v1DAQhi0EokvhB3BBOXJJGH_kY4WEFFVAVyqqVApXy3YmqkMSL56k1f57vNrCgUMPlmX5eV9pnmHsLYeCA68-DMVwT4UAAQWUBYj6Gdtw2NZ51cD2OdtArXheCq7O2CuiAYDzsqlfsjMpVC2lgg0bd7OLaAi77DLQ3i9mzH6GcZ0w21HWEgXnzZJ-H_xyl91gt7r0-BZiAv1yyNp-wZjd3oVoXDC2C5OfU0WbAO-ydsY1HmhKwb3x8TV70ZuR8M3jfc5-fPl8e3GZX11_3V20V7lTJV9yq0RvrOW849xIpRrRq9IK68rSVJ1FrDpsZKOcdHVX2x4UVD1I25RGuMqhPGfvT737GH6vSIuePDkcRzNjWEkLBQ3fVukklJ9QFwNRxF7vo59MPGgO-ihZDzpJ1kfJGkqdJKfMu8f61U7Y_Uv8tZqAjycA05D3HqMm53FO5nxEt-gu-CfrP_2XdqOfvTPjLzwgDWGNSTFprklo0N-PWz4uWYDkohFb-QcAb6N7</recordid><startdate>20210201</startdate><enddate>20210201</enddate><creator>Polanco, Antonio R., MD</creator><creator>D’Angelo, Alex M., MD</creator><creator>Shea, Nicholas J., MD, MS</creator><creator>Allen, Philip, BS</creator><creator>Takayama, Hiroo, MD, PhD</creator><creator>Patel, Virendra I., MD, MPH</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20210201</creationdate><title>Increased Hospital Volume Is Associated with Reduced Mortality After Thoracoabdominal Aortic Aneurysm Repair</title><author>Polanco, Antonio R., MD ; D’Angelo, Alex M., MD ; Shea, Nicholas J., MD, MS ; Allen, Philip, BS ; Takayama, Hiroo, MD, PhD ; Patel, Virendra I., MD, MPH</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c451t-b42fabb11d11a34482f45b2bc55a6dbee6de8384c3c7d7bf0406f03b85a2c6ce3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aortic repair</topic><topic>Mortality</topic><topic>Surgery</topic><topic>Thoracoabdominal aortic aneurysm</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Polanco, Antonio R., MD</creatorcontrib><creatorcontrib>D’Angelo, Alex M., MD</creatorcontrib><creatorcontrib>Shea, Nicholas J., MD, MS</creatorcontrib><creatorcontrib>Allen, Philip, BS</creatorcontrib><creatorcontrib>Takayama, Hiroo, MD, PhD</creatorcontrib><creatorcontrib>Patel, Virendra I., MD, MPH</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Polanco, Antonio R., MD</au><au>D’Angelo, Alex M., MD</au><au>Shea, Nicholas J., MD, MS</au><au>Allen, Philip, BS</au><au>Takayama, Hiroo, MD, PhD</au><au>Patel, Virendra I., MD, MPH</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Increased Hospital Volume Is Associated with Reduced Mortality After Thoracoabdominal Aortic Aneurysm Repair</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2021-02-01</date><risdate>2021</risdate><volume>73</volume><issue>2</issue><spage>451</spage><epage>458</epage><pages>451-458</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><abstract><![CDATA[ABSTRACTObjectivesContemporary data on outcomes in open thoracoabdominal aortic aneurysm (TAAA) repair is limited to reports from major aortic referral centers showing excellent outcomes. This study aims to characterize the national experience of open TAAA repair using national outcomes data, with a primary focus to examine the association of hospital volume with mortality and morbidity. MethodsThe Nationwide Inpatient Sample was queried from 1998-2011 and all patients with a diagnosis of TAAA who underwent open operative repair were included. These patients were further stratified into tertiles based on the operative volume of the institution that performed their operation: low volume (LV, <3 cases/year), medium volume (MV, 3-11 cases/year), high volume (HV, ≥12 cases/year). Baseline demographics as well as perioperative outcomes were compared between these groups. Multivariable logistic regression was performed to determine predictors of operative mortality and morbidity. Subgroup analyses were performed for patients presenting for elective surgery (ESC) and for those presenting for urgent and emergent surgery (UEC). ResultsOverall operative mortality was 21% for the entire cohort. Operative mortality was higher at LV (26%) and MV (21%) centers compared to HV centers (15%) (p<0.001). This difference was similar in both the ESC (LV 18% and MV 14% vs HV 12%, p<0.001) as well as the UEC (LV 34% and MV 30% vs HV 19%, p<0.001). Further, rates of blood transfusion as well as acute renal failure were significantly lower in the HV group. Multivariable analysis revealed that, compared to the HV group, patients operated on at LV centers (OR 1.9, 95% CI 1.7-2.1, p<0.001) and MV centers (OR 1.5, 95% CI 1.4-1.7, p<0.001) had at least 1.5x the odds of in-hospital mortality. The HV group also has significantly lower odds of dying in the subgroup analyses of both the ESC and the UEC. Increasing TAAA volume was associated with increased use of distal aortic perfusion (OR 1.03, 95% CI 1.02 – 1.03, p<0.001). ConclusionsPatients with TAAA in the United States operated on at HV centers have significantly lower mortality and morbidity compared to lower volume centers. Consideration of referral to HV centers may be warranted, but further research is required to justify this conclusion.]]></abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32473340</pmid><doi>10.1016/j.jvs.2020.05.027</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| source | BACON - Elsevier - GLOBAL_SCIENCEDIRECT-OPENACCESS |
| subjects | Aortic repair Mortality Surgery Thoracoabdominal aortic aneurysm |
| title | Increased Hospital Volume Is Associated with Reduced Mortality After Thoracoabdominal Aortic Aneurysm Repair |
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