PURPOSE: To evaluate the impact of individual institutions on the outcome after surgery for Stanford type A aortic dissection (TAAD). METHODS: This is an observational, multicenter, retrospective cohort study including 3902 patients who underwent surgery for TAAD at 18 university and non-university hospitals. RESULTS: Logistic 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). CONCLUSION: The 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 REGISTRATION: ClinicalTrials.gov Identifier: NCT04831073.

Anesthesia and Critical Care Research Unit of Surgery University of Oulu Oulu Finland

Cardiac Surgery Molinette Hospital University of Turin Turin Italy

Cardiothoracic Department University Hospital Udine Italy

Cardiovascular Surgery Department University Hospital Gregorio Marañón Madrid Spain

Center for Global Health National Health Institute Rome Italy

Centre Hospitalier Annecy Genevois Épagny Metz Tessy France

Department of Cardiac Surgery 3rd Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic

Department of Cardiac Surgery Centre Cardiologique du Nord de Saint Denis Paris France

Department of Cardiac Surgery Glenfield Hospital Leicester UK

Department of Cardiac Surgery Hôpitaux Universitaires Henri Mondor Assistance Publique Hôpitaux de Paris Creteil France

Department of Cardiac Surgery Ziekenhuis Oost Limburg Genk Belgium

Department of Cardiothoracic Surgery University Hospital Muenster Muenster Germany

Department of Cardiovascular Surgery Hospital Clínic de Barcelona University of Barcelona Barcelona Spain

Department of Cardiovascular Surgery University Heart and Vascular Center Hamburg Hamburg Germany

Department of Medicine South Karelia Central Hospital University of Helsinki Lappeenranta Finland

Department of Thoracic and Cardiovascular Surgery University of Franche Comte Besancon France

Department of Vascular Surgery Hôpitaux Universitaires Henri Mondor Assistance Publique Hôpitaux de Paris Creteil France

Division of Cardiac Surgery Cardio Thoracic and Vascular Department Azienda Sanitaria Universitaria Giuliano Isontina Trieste Italy

Division of Cardiac Surgery University of Verona Medical School Verona Italy

German Centre for Cardiovascular Research Partner Site Munich Heart Alliance Munich Germany

Heart and Lung Center Helsinki University Hospital University of Helsinki 00029 Helsinki Finland

Liverpool Centre for Cardiovascular Sciences Liverpool Heart and Chest Hospital Liverpool UK

LMU University Hospital Ludwig Maximilian University Munich Germany

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ClinicalTrials.gov
NCT04831073