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. 2007 Oct;142(4):524-8; discussion 528.e1.
doi: 10.1016/j.surg.2007.07.012.

A contemporary analysis of outcomes for operative repair of type A aortic dissection in the United States

Brian S Knipp  1 , G Michael Deeb, Richard L Prager, Candace Y Williams, Gilbert R Upchurch Jr, Himanshu J Patel
Affiliations

A contemporary analysis of outcomes for operative repair of type A aortic dissection in the United States

Brian S Knipp et al. Surgery. 2007 Oct.

Erratum in

  • Surgery. 2008 Feb;143(2):301

Abstract

Background: Despite recent advances, reported mortality rates after repair for acute type A aortic dissection vary from 5% to 30%. This study was conducted to assess cross-sectional mortality after operative repair of type A dissection in the United States, and to determine whether a volume-outcome relationship exists for this operative procedure.

Methods: Data were obtained from the Nationwide Inpatient Sample, which is a cross-sectional administrative database incorporating 20% of all annual US hospital discharges. From 1995 to 2003, a cohort of 3013 patients with thoracic or thoracoabdominal dissection who underwent aortic resection was identified. Patient demographics, hospital volumes, and teaching status were included as independent variables.

Results: The mean age was 62 +/- 14 years (65% male). In-hospital mortality for the study period was 26%, but it decreased from 27% in 1995 to 23% in 2003 (P = .03). A significant correlation was found between procedural volume and mortality (P < .001). By multivariate analysis, independent predictors of mortality included increasing age (P < .0001) and operation at a non-teaching hospital (P = .002).

Conclusions: Operative mortality for repair of ascending aortic dissection in the United States has shown modest temporal improvements. More importantly, operative mortality seems to be dependent on the arena of care.

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