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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Article info
Publication history
Accepted:
July 3,
2007
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
ScienceDirect
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- ErratumSurgeryVol. 143Issue 2
- PreviewAs 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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