• J. Cardiothorac. Vasc. Anesth. · Oct 2024

    Hospital Teaching Status and Outcomes in Type B Aortic Dissection: Analysis of More Than 40,000 Patients.

    • Danial Ahmad, Michel Pompeu Sá, James A Brown, Sarah Yousef, Yisi Wang, Derek Serna-Gallegos, David West, Pyongsoo Yoon, David Kaczorowski, Johannes Bonatti, Danny Chu, Francis D Ferdinand, Julie Phillippi, and Ibrahim Sultan.
    • Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
    • J. Cardiothorac. Vasc. Anesth. 2024 Oct 28.

    ObjectiveTo assess the association of hospital teaching status with outcomes of patients presenting with type B aortic dissection (TBAD).DesignRetrospective cross-sectional study of the National Readmissions Database (NRD), from 2016 to 2020.SettingHospitals across the United States stratified by teaching status.ParticipantsTBAD patients.InterventionsSurgical repair, thoracic endovascular aortic repair (TEVAR), and conservative medical management.Measurements And Main ResultsA total of 44,981 TBAD patients were included, of whom 5421 (12%) were managed at a nonteaching (NT) hospital and 39,470 (88%) were treated at a teaching (T) hospital. Propensity score matching (1:1) yielded 4676 matched pairs. In-hospital mortality (12.9% for NT vs 12.5% for T; p = 0.58) and 30-day readmission (23.3% for NT vs 21.8% for T; p = 0.12) outcomes were not statistically significantly different between the groups. On multivariable regression, teaching status was not associated with higher odds of in-hospital mortality (odds ratio [OR], 0.943; 95% confidence interval [CI, 0.841-1.057; p = 0.31) or 30-day readmission (OR, 0.965; 95% CI, 0.88-1.058; p = 0.44). At teaching hospitals, TEVAR was associated with higher odds of in-hospital mortality (OR, 1.898; 95% CI, 1.596-2.257; p < .01), while hospital volume was associated with higher odds of 30-day readmission (quartile 3: OR, 1.488; 95% CI, 1.106-2.002; quartile 4: OR, 1.684; 95% CI, 1.256-2.257; p < 0.01).ConclusionsHospital teaching status alone was not associated with in-hospital mortality or 30-day readmission in TBAD patients. At teaching hospitals, management by TEVAR and greater hospital volume were associated with in-hospital mortality and 30-day readmission outcome, respectively.Copyright © 2024 Elsevier Inc. All rights reserved.

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