ArticleJournal of cardiothoracic surgery2016
Outcomes following emergent open repair for thoracic aortic dissection are improved at higher volume centers in direct admissions and transfers.
Article in Journal of cardiothoracic surgery, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 29 citations in OpenAlex.
- From routine to rescue: Higher elective aortic surgery volume is associated with improved outcomes after acute type A aortic dissection repair.JTCVS open · 2026Article
- Interfacility Transfer and Mortality in Patients With Type A Acute Aortic Dissection - Analysis of the Tokyo Acute Aortic Super-Network Database.Circulation reports · 2026Article
- Lactate as a Preoperative Predictor of Mortality in Patients Undergoing Emergency Type A Aortic Dissection Repair.Journal of personalized medicine · 2025Review
- Influence of Surgical Expertise on Repair of Acute Type a Aortic Dissection in a Standardized Operative Setting.Journal of clinical medicine · 2025Article
- The optimal annual case volume for acute type A aortic dissection surgery in relation to long-term outcomes.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2025Article
- Impact of an emergency department bypass referral pathway for surgically managed Type A aortic dissection diagnosed at non-aortic centers.Frontiers in public health · 2025Article
- Article
- Factors affecting the length of stay in the emergency department for critically Ill patients transferred to regional emergency medical center.Nursing open · 2023Article
- Impact of unintentional coronary angiography on outcomes of emergency surgery in acute type A aortic dissection: a retrospective study.BMC cardiovascular disorders · 2022Article
- Surgical Outcomes of Type A Aortic Dissection at a Small-Volume Medical Center: Analysis according to the Extent of Surgery.The Korean journal of thoracic and cardiovascular surgery · 2020Article
- Adult lung transplantation case-volume and in-hospital and long-term mortality in Korea.Journal of cardiothoracic surgery · 2019Article
- How should we manage type A aortic dissection?General thoracic and cardiovascular surgery · 2019Review
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Authors and funding
7 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe purpose of this study is (1) to define the proportion of patients undergoing emergent open repair of thoracic aortic dissection admitted directly through the emergency room versus those transferred from outside hospitals and (2) to determine if a volume-outcomes relationship exists for those patients across admission types.
methodsDe-identified patient-level data was obtained from the Nationwide Inpatient Sample (2004-2008). Patients undergoing emergent aortic surgery for thoracic aortic dissection (n = 1,507) were identified by ICD-9 codes and stratified by annual center volume into low volume (≤5 cases/year) (n = 963; 63.9 %), intermediate volume (6-10 cases/year) (n = 370; 24.5 %), and high volume (≥11 cases/year) (n = 174; 11.6 %) groups. The analysis was further stratified by admission type: direct admission (DA), transfer admission (TA), and other. The primary outcome was in-hospital mortality. Multivariate logistic regression analysis was performed comparing outcomes between high vs low and high vs intermediate volume centers.
resultsOverall in-hospital mortality was 21.8 % (n = 328/1,507). Absolute percent mortality at high volume centers was significantly lower (12.6 %) than at medium (20.6 %) and low volume (23.9 %) centers. For DA patients, mortality was 10.6, 21.4, and 24.0 % for high, medium, and low volume centers respectively. For TA patients, mortality was 10.2, 12.7, and 23.5 % for high, medium, and low volume centers, respectively. Multivariate analysis suggested that patients in low volume center were more likely to die compared to high volume center (Odds Ratio 2.06, 95 % CI 1.25 - 3.38, p = 0.004). Admission source was not associated with increased mortality.
conclusionsDirect admissions comprise the largest proportion of dissections regardless of volume strata, and they comprise the largest proportion in the low and intermediate volume cohorts. Admission to low volume center is an independent risk factor for increased mortality. Patients transferred to high volume centers from low volume centers have similar outcome as direct admits in terms of mortality.
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