Higher surgeon volume is associated with lower odds of complication following thoracic endovascular aortic repair for aortic dissections

• Published in: Journal of vascular surgery 2022-10, Vol.76 (4), p.884-890
• Main Authors: Cooke, Peter V., Png, C.Y. Maximilian, George, Justin M., Eagleton, Matthew J., Tadros, Rami O.
• Format: Article
• Language: English
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2022.06.027

OBJECTIVEThis study aimed to understand the impact of surgeon volume on outcomes of thoracic endovascular aortic repair (TEVAR) in patients being treated for aortic dissection. METHODSPatients undergoing TEVAR from January 2014 to March 2021 in the Vascular Quality Initiative database were analyzed. Patients with aortic dissection who underwent TEVAR were divided into quartiles based on the annual TEVAR volume of their vascular surgeon. The highest quartile, middle two quartiles, and lowest quartile were deemed high volume (HV), moderate volume (MV), and low volume (LV), respectively. Multivariable logistic regressions were performed to compare cohort outcomes in terms any postoperative complication, stroke, spinal cord ischemia, reintervention, and 30-day mortality. A Cox proportional hazard model was used to assess the hazard of overall postoperative mortality. RESULTSAmong 1217 patients undergoing TEVAR, 321, 621, and 275 were performed by HV, MV, and LV surgeons, respectively. HV surgeons performed >19 annual TEVARs, MV surgeons between five and 18, and LV surgeons four or less. Adjusted odds of any postoperative complication revealed that HV and MV surgeons had lower odds of overall postoperative complications (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.30-0.85; P = .011 and OR, 0.60; 95% CI, 0.38-0.87; P = .008, respectively) when compared with patients of LV surgeons. Patients of HV surgeons had lower odds of respiratory complications than those of LV surgeons (OR, 0.42; 95% CI, 0.17-0.93; P = .039). Adjusted analysis of outcomes including spinal cord ischemia, stroke, myocardial infarction, 30-day mortality, and overall mortality did not reveal statistically significant differences between cohorts. CONCLUSIONSSurgeon volume does not to impact 30-day mortality or long-term mortality after TEVAR for aortic dissection, but the odds of overall postoperative complications were lower for HV and MV surgeons when compared with LV surgeons.