Key result
Undergoing thoracic aorta replacement surgery in low-volume centers was associated with a significantly higher risk of in-hospital mortality compared to high-volume centers (adjusted OR 3.12).
Why the study?
Thoracic aorta surgery carries high postoperative mortality, and the relationship between institutional case volume and postoperative mortality needed evaluation.
Does institutional case volume affect mortality in adult patients undergoing thoracic aorta replacement surgery?
Cohort (n=4,867)
Yes
Does institutional case volume affect mortality in adult patients undergoing thoracic aorta replacement surgery?
Odds Ratio: 3.12 (95% CI 2.54–3.85)
Absolute Event Rate: 21.9% vs 8.6%
p-value: p=<0.001
Patients undergoing thoracic aorta replacement surgery at lower volume centers have a significantly increased risk of in-hospital and long-term mortality compared to those treated at high volume centers.
Lower-volume centers associated with higher mortality after thoracic aortic replacement; hypothesis-generating and should not yet change referral patterns.
BACKGROUND: The inverse relationship between case volume and postoperative mortality following high-risk surgical procedures have been reported. Thoracic aorta surgery is associated with one of the highest postoperative mortality. The relationship between institutional case volume and postoperative mortality in patients undergoing thoracic aorta replacement surgery was evaluated. METHODS: All thoracic aorta replacement surgeries performed in Korea between 2009 and 2016 in adult patients were analyzed using an administrative database. Hospitals were divided into low (< 30 cases/year), medium (30-60 cases/year), or high (> 60 cases/year) volume centers depending on the annual average number of thoracic aorta replacement surgeries performed. The impact of case volume on in-hospital mortality was assessed using the logistic regression. RESULTS: Across 83 hospitals, 4867 cases of thoracic aorta replacement were performed. In-hospital mortality was 8.6% (191/2222), 10.7% (77/717), and 21.9% (422/1928) in high, medium, and low volume centers, respectively. The adjusted risk of in-hospital mortality was significantly higher in medium (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.16-2.11, P = 0.004) and low volume centers (OR, 3.12; 95% CI, 2.54-3.85, P < 0.001) compared to high volume centers. CONCLUSIONS: Patients who had underwent thoracic aorta replacement surgery in lower volume centers had increased risk of in-hospital mortality after surgery compared to those in higher volume centers. Our results may provide the basis for minimum case volume requirement or regionalization in thoracic aorta replacement surgery for optimal patient outcome.
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Nam et al. (2020) conducted a cohort in Thoracic aorta replacement (n=4,867). Low institutional case volume (< 30 cases/year) vs. High institutional case volume (> 60 cases/year) was evaluated on In-hospital mortality (OR 3.12, 95% CI 2.54-3.85, p=<0.001). Undergoing thoracic aorta replacement surgery in low-volume centers was associated with a significantly higher risk of in-hospital mortality compared to high-volume centers (adjusted OR 3.12).
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