ArticleEuropean heart journal2023
Type A aortic dissection: optimal annual case volume for surgery.
Article in European heart journal, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 3 of them syntheses that pooled it.
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Who cites it
15 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- The prognostic impact of prevailing definitions of periprocedural myocardial infarction in patients undergoing coronary artery bypass grafting.European heart journal. Quality of care & clinical outcomes · 2025Pooled it
- The volume-outcome relationship for pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension.The European respiratory journal · 2025Pooled it
- Short- and long-term outcomes in isolated vs. hybrid thoracoscopic ablation in patients with atrial fibrillation: a systematic review and reconstructed individual patient data meta-analysis.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Pooled it
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- From routine to rescue: Higher elective aortic surgery volume is associated with improved outcomes after acute type A aortic dissection repair.JTCVS open · 2026Article
- Valve-sparing Aortic Root Replacement: Defining High-volume Centres Using Prospective Data.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2026Article
- Early Prone Positioning After Acute Type A Aortic Dissection Surgery for Moderate-to-Severe Acute Respiratory Distress Syndrome Is Safe and Shortens Duration of Mechanical Ventilation.Critical care explorations · 2026Article
- The GERAADA Risk Score for Early Mortality After Surgery for Acute Type A Aortic Dissection: An External Validation in the Dutch Setting.Interdisciplinary cardiovascular and thoracic surgery · 2026Article
- A comprehensive multidisciplinary thoracic aortic program improves patient quality metrics after type A aortic dissection repair.JTCVS open · 2026Article
- A Type-Entry-Malperfusion-Based Propensity Score Matched Analysis Depending on Surgical Expertise in Patients Without Malperfusion Undergoing Surgery for Acute Type A Aortic Dissection.Interdisciplinary cardiovascular and thoracic surgery · 2026Article
- Impact of an On-Call Specialist Aortic Rota Implementation in Acute Type a Aortic Dissection on Outcomes and Repair Complexity: A Retrospective Cohort Study.Interdisciplinary cardiovascular and thoracic surgery · 2025Article
- Validation of the GERAADA Score for Predicting 30-Day Mortality Rate in Acute Type A Aortic Dissection: A Single-Center Study in China.Journal of the American Heart Association · 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
- Defining the optimal annual institutional case volume for minimally invasive repair of pectus excavatum through a systematic review of literature and meta-analysis of outcomes.Journal of thoracic disease · 2024Article
- Long-Term Results and Quality of Life after Surgery for Acute Aortic Dissection Type A: Contemporary Single-Centre Experience.Journal of clinical medicine · 2024Article
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7 authors.
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No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
aimsThe current study proposes a novel volume-outcome (V-O) meta-analytical approach to determine the optimal annual hospital case volume threshold for cardiovascular interventions in need of centralization. This novel method is applied to surgery for acute type A aortic dissection (ATAAD) as an illustrative example.
methodsA systematic search was applied to three electronic databases (1 January 2012 to 29 March 2023). The primary outcome was early mortality in relation to annual hospital case volume. Data were presented by volume quartiles (Qs). Restricted cubic splines were used to demonstrate the V-O relation, and the elbow method was applied to determine the optimal case volume. For clinical interpretation, numbers needed to treat (NNTs) were calculated.
resultsOne hundred and forty studies were included, comprising 38 276 patients. A significant non-linear V-O effect was observed (P < .001), with a notable between-quartile difference in early mortality rate [10.3% (Q4) vs. 16.2% (Q1)]. The optimal annual case volume was determined at 38 cases/year [95% confidence interval (CI) 37-40 cases/year, NNT to save a life in a centre with the optimal volume vs. 10 cases/year = 21]. More pronounced between-quartile survival differences were observed for long-term survival [10-year survival (Q4) 69% vs. (Q1) 51%, P < .01, adjusted hazard ratio 0.83, 95% CI 0.75-0.91 per quartile, NNT to save a life in a high-volume (Q4) vs. low-volume centre (Q1) = 6].
conclusionsUsing this novel approach, the optimal hospital case volume threshold was statistically determined. Centralization of ATAAD care to high-volume centres may lead to improved outcomes. This method can be applied to various other cardiovascular procedures requiring centralization.
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