• Fausto Biancari, Angelo M Dell'Aquila, Giuseppe Gatti, Andrea Perrotti, Amélie Hervé, Joseph Touma, Matteo Pettinari, Sven Peterss, Joscha Buech, Konrad Wisniewski, Tatu Juvonen, Mikko Jormalainen, Caius Mustonen, Andreas Rukosujew, Till Demal, Lenard Conradi, Marek Pol, Petr Kacer, Francesco Onorati, Cecilia Rossetti, Igor Vendramin, Daniela Piani, Mauro Rinaldi, Luisa Ferrante, Eduard Quintana, Robert Pruna-Guillen, Javier Rodriguez Lega, Angel G Pinto, Metesh Acharya, Zein El-Dean, Mark Field, Amer Harky, Manoj Kuduvalli, Francesco Nappi, Sebastien Gerelli, Di PernaDarioDCentre Hospitalier Annecy Genevois, Épagny-Metz-Tessy, France., Enzo Mazzaro, Stefano Rosato, Antonio Fiore, and Giovanni Mariscalco.
• Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029, Helsinki, Finland. faustobiancari@yahoo.it.
• Eur J Trauma Emerg Surg. 2023 Aug 1; 49 (4): 179118011791-1801.

PurposeTo evaluate the impact of individual institutions on the outcome after surgery for Stanford type A aortic dissection (TAAD).MethodsThis is an observational, multicenter, retrospective cohort study including 3902 patients who underwent surgery for TAAD at 18 university and non-university hospitals.ResultsLogistic regression showed that four hospitals had increased risk of in-hospital mortality, while two hospitals were associated with decreased risk of in-hospital mortality. Risk-adjusted in-hospital mortality rates were lower in four hospitals and higher in other four hospitals compared to the overall in-hospital mortality rate (17.7%). Participating hospitals were classified as overperforming or underperforming if their risk-adjusted in-hospital mortality rate was lower or higher than the in-hospital mortality rate of the overall series, respectively. Propensity score matching yielded 1729 pairs of patients operated at over- or underperforming hospitals. Overperforming hospitals had a significantly lower in-hospital mortality (12.8% vs. 22.2%, p < 0.0001) along with decreased rate of stroke and/or global brain ischemia (16.5% vs. 19.9%, p = 0.009) compared to underperforming hospitals. Aggregate data meta-regression of the results of participating hospitals showed that hospital volume was inversely associated with in-hospital mortality (p = 0.043). Hospitals with an annual volume of less than 15 cases had an increased risk of in-hospital mortality (adjusted OR, 1.345, 95% CI 1.126-1.607).ConclusionThe present findings indicate that there are significant differences between hospitals in terms of early outcome after surgery for TAAD. Low hospital volume may be a determinant of poor outcome of TAAD.Trial RegistrationClinicalTrials.gov Identifier: NCT04831073.© 2023. The Author(s).

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