Central Surgical Association| Volume 142, ISSUE 4, P524-528.e1, October 2007

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


      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.


      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.


      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).


      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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        • Anagnostopoulos C.E.
        • Prabhakar M.J.
        • Kittle C.F.
        Aortic dissections and dissecting aneurysms.
        Am J Cardiol. 1972; 30: 263
        • Bavaria J.E.
        • Woo Y.J.
        • Hall R.A.
        • Wahl P.M.
        • Acker M.A.
        • Gardner T.J.
        Circulatory management with retrograde cerebral perfusion for acute Type A aortic dissection.
        Circulation. 1996; 92: II793-II796
        • Fann J.I.
        • Smith J.A.
        • Miller D.C.
        • Mitchell R.S.
        • Moore K.A.
        • Grunkemeier G.
        • et al.
        Surgical management of aortic dissection during a 30-year period.
        Circulation. 1995; 92: II113-II121
        • Hagan P.G.
        • Nienaber C.A.
        • Isselbacher E.M.
        • Bruckman D.
        • Karavite D.J.
        • Russman P.L.
        • et al.
        The International Registry of Acute Aortic Dissection: new insights into an old disease.
        JAMA. 2000; 283: 897-903
        • Trimarchi S.
        • Nienaber C.A.
        • Rampoldi V.
        • Myrmel T.
        • Suzuki T.
        • Mehta R.H.
        • et al.
        Contemporary results of surgery in acute Type A aortic dissection: the International Registry of Acute Aortic Dissection experience.
        J Thorac Cardiovasc Surg. 2005; 129: 112-122
        • Bavaria J.E.
        • Pochettino A.
        • Brinster D.R.
        • Gorman R.C.
        • McGarvey M.L.
        • Gorman J.H.
        • et al.
        New paradigms and improved results for the surgical treatment of acute Type A dissection.
        Ann Surg. 2001; 234: 336-343
        • David T.E.
        • Armstrong S.
        • Ivanov J.
        • Barnard S.
        Surgery for acute Type A dissection.
        Ann Thorac Surg. 1999; 67: 1999-2001
        • Dimick J.B.
        • Pronovost P.J.
        • Cowan J.A.
        • Lipsett P.A.
        • Stanley J.C.
        • Upchurch Jr, G.R.
        Variation in postoperative complication rates after high risk surgery in the United States.
        Surgery. 2003; 134: 534-541
        • Rathore S.S.
        • Epstein A.J.
        • Volpp K.G.M.
        • Krumholz H.M.
        Hospital coronary artery bypass graft surgery volume and patient mortality, 1998-2000.
        Ann Surg. 2004; 239: 110-117
        • Dimick J.B.
        • Wainess R.M.
        • Upchurch G.R.
        • Iannettoni M.D.
        • Orringer M.B.
        National trends in outcomes for esophageal resection.
        Ann Thorac Surg. 2005; 79: 212-218
      1. Website for Heathcare Cost and Utilization Project. (H-CUP). Available from:

        • Romano P.S.
        • Roos L.L.
        • Jollis J.G.
        Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives.
        J Clin Epidemiol. 1993; 46: 1075-1079
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method for classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Deyo R.A.
        • Cherkin D.C.
        • Ciol M.A.
        Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.
        J Clin Epidemiol. 1992; 45: 613-619
        • Erlich M.P.
        • Ergin M.A.
        • McCullough J.N.
        • Lansman S.L.
        • Galla J.D.
        • Bodian C.A.
        • et al.
        Results of immediate surgical treatment of all acute Type A dissections.
        Circulation. 2000; 102: III248-III252
        • Svensson L.G.
        • Crawford E.S.
        • Hess K.R.
        • Coselli J.S.
        • Safi H.J.
        Dissection of the aorta and dissecting aortic aneurysms.
        Circulation. 1990; 82: IV24-IV38
        • Jollis J.G.
        • Ancukewicz M.
        • DeLong E.R.
        • Pryor D.B.
        • Muhlbaier L.H.
        • Mark D.B.
        Discordance of databases designed for claims payment versus clinical information systems: implications for clinical research.
        Ann Intern Med. 1993; 119: 844-850
        • Quan H.
        • Parsons G.A.
        • Ghali W.A.
        Validity of procedure codes in International Classification of Diseases, 9th revision, Clinical Modification Administrative Data.
        Med Care. 2004; 42: 801-809
        • Romano P.S.
        • Mark D.H.
        Bias in the coding of hospital discharge data and its implications for quality assessment.
        Med Care. 1994; : 81-90
        • Lawthers A.G.
        • McCarthy E.P.
        • Davis R.B.
        • Peterson L.E.
        • Palmer R.H.
        • Iezzoni L.I.
        Identification of in-hospital complications from claims data: is it valid?.
        Med Care. 2000; 38: 785-795
        • Berthelsen C.L.
        Evaluation of coding data quality of the HCUP National Inpatient Sample.
        Top Health Inform Manage. 2000; 21: 10-23

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      • Erratum
        SurgeryVol. 143Issue 2
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          As a result of a production error, several articles appearing in the Central Surgical Association (Surgery, 2007; Vol. 142, No. 4:433-644) and American Association of Endocrine Surgeons (Surgery, 2007; Vol. 142, No. 6:785-1030) special focus issues were published without their respective discussions. The articles affected have now been updated online to include the missing discussion material. Surgery apologizes to the authors for this significant oversight.
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