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. 2017 Aug;154(2):398-406.e1.
doi: 10.1016/j.jtcvs.2017.02.015. Epub 2017 Feb 14.

Acute type A aortic dissection in the United Kingdom: Surgeon volume-outcome relation

Mohamad Bashir  1 , Amer Harky  2 , Matthew Fok  3 , Matthew Shaw  4 , Graeme L Hickey  5 , Stuart W Grant  6 , Rakesh Uppal  2 , Aung Oo  7
Affiliations
Free article

Acute type A aortic dissection in the United Kingdom: Surgeon volume-outcome relation

Mohamad Bashir et al. J Thorac Cardiovasc Surg. 2017 Aug.
Free article

Abstract

Objectives: Surgery for acute type A aortic dissection (ATAD) carries a high risk of operative mortality. We examined the surgeon volume-outcome relation with respect to in-hospital mortality for patients presenting with this pathology in the United Kingdom.

Method: Between April 2007 and March 2013, 1550 ATAD procedures were identified from the National Institute for Cardiovascular Outcomes Research database. A total of 249 responsible consultant cardiac surgeons from the United Kingdom recorded 1 or more of these procedures in their surgical activity over this period. We describe the patient population and mortality rates, focusing on the relationship between surgeon volume and in-hospital mortality.

Results: The mean annual volume of procedures per surgeon during the 6-year period ranged from 1 to 6.6. The overall in-hospital mortality rate was 18.3% (283/1550). A mortality improvement at the 95% level was observed with a risk-adjusted mean annual volume >4.5. Surgeons with a mean annual volume <4 over the study period had significantly higher in-hospital mortality rates in comparison with surgeons with a mean annual volume ≥4 (19.3% vs 12.6%; P = .015).

Conclusions: Patients with ATAD who are operated on by lower-volume surgeons experience higher levels of in-hospital mortality. Directing these patients to higher-volume surgeons may be a strategy to reduce in-hospital mortality.

Keywords: AAD; aneurysm; aorta; dissection; surgeon volume-outcome.

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