Association between institutional case volume and mortality following thoracic aorta replacement: a nationwide Korean cohort study
Abstract Background The inverse relationship between case volume and postoperative mortality following high-risk surgical procedures have been reported. Thoracic aorta surgery is associated with one of the highest postoperative mortality. The relationship between institutional case volume and postop...
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| Format: | Article |
| Language: | English |
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BMC
2020-06-01
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| Series: | Journal of Cardiothoracic Surgery |
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| Online Access: | http://link.springer.com/article/10.1186/s13019-020-01204-0 |
| _version_ | 1819116199318913024 |
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| author | Karam Nam Eun Jin Jang Jun Woo Jo Jae Woong Choi Minkyoo Lee Ho Geol Ryu |
| author_facet | Karam Nam Eun Jin Jang Jun Woo Jo Jae Woong Choi Minkyoo Lee Ho Geol Ryu |
| author_sort | Karam Nam |
| collection | DOAJ |
| description | Abstract Background The inverse relationship between case volume and postoperative mortality following high-risk surgical procedures have been reported. Thoracic aorta surgery is associated with one of the highest postoperative mortality. The relationship between institutional case volume and postoperative mortality in patients undergoing thoracic aorta replacement surgery was evaluated. Methods All thoracic aorta replacement surgeries performed in Korea between 2009 and 2016 in adult patients were analyzed using an administrative database. Hospitals were divided into low (< 30 cases/year), medium (30–60 cases/year), or high (> 60 cases/year) volume centers depending on the annual average number of thoracic aorta replacement surgeries performed. The impact of case volume on in-hospital mortality was assessed using the logistic regression. Results Across 83 hospitals, 4867 cases of thoracic aorta replacement were performed. In-hospital mortality was 8.6% (191/2222), 10.7% (77/717), and 21.9% (422/1928) in high, medium, and low volume centers, respectively. The adjusted risk of in-hospital mortality was significantly higher in medium (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.16–2.11, P = 0.004) and low volume centers (OR, 3.12; 95% CI, 2.54–3.85, P < 0.001) compared to high volume centers. Conclusions Patients who had underwent thoracic aorta replacement surgery in lower volume centers had increased risk of in-hospital mortality after surgery compared to those in higher volume centers. Our results may provide the basis for minimum case volume requirement or regionalization in thoracic aorta replacement surgery for optimal patient outcome. |
| first_indexed | 2024-12-22T05:13:17Z |
| format | Article |
| id | doaj.art-e51e39e2a020486895eedd0c7117a77e |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-12-22T05:13:17Z |
| publishDate | 2020-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-e51e39e2a020486895eedd0c7117a77e2022-12-21T18:37:55ZengBMCJournal of Cardiothoracic Surgery1749-80902020-06-011511910.1186/s13019-020-01204-0Association between institutional case volume and mortality following thoracic aorta replacement: a nationwide Korean cohort studyKaram Nam0Eun Jin Jang1Jun Woo Jo2Jae Woong Choi3Minkyoo Lee4Ho Geol Ryu5Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of MedicineDepartment of Information Statistics, Andong National UniversityDepartment of Statistics, Kyungpook National UniversityDepartment of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of MedicineDepartment of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of MedicineDepartment of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of MedicineAbstract Background The inverse relationship between case volume and postoperative mortality following high-risk surgical procedures have been reported. Thoracic aorta surgery is associated with one of the highest postoperative mortality. The relationship between institutional case volume and postoperative mortality in patients undergoing thoracic aorta replacement surgery was evaluated. Methods All thoracic aorta replacement surgeries performed in Korea between 2009 and 2016 in adult patients were analyzed using an administrative database. Hospitals were divided into low (< 30 cases/year), medium (30–60 cases/year), or high (> 60 cases/year) volume centers depending on the annual average number of thoracic aorta replacement surgeries performed. The impact of case volume on in-hospital mortality was assessed using the logistic regression. Results Across 83 hospitals, 4867 cases of thoracic aorta replacement were performed. In-hospital mortality was 8.6% (191/2222), 10.7% (77/717), and 21.9% (422/1928) in high, medium, and low volume centers, respectively. The adjusted risk of in-hospital mortality was significantly higher in medium (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.16–2.11, P = 0.004) and low volume centers (OR, 3.12; 95% CI, 2.54–3.85, P < 0.001) compared to high volume centers. Conclusions Patients who had underwent thoracic aorta replacement surgery in lower volume centers had increased risk of in-hospital mortality after surgery compared to those in higher volume centers. Our results may provide the basis for minimum case volume requirement or regionalization in thoracic aorta replacement surgery for optimal patient outcome.http://link.springer.com/article/10.1186/s13019-020-01204-0Case volumeSurgical prognosisThoracic aorta replacementVolume-outcome relationship |
| spellingShingle | Karam Nam Eun Jin Jang Jun Woo Jo Jae Woong Choi Minkyoo Lee Ho Geol Ryu Association between institutional case volume and mortality following thoracic aorta replacement: a nationwide Korean cohort study Journal of Cardiothoracic Surgery Case volume Surgical prognosis Thoracic aorta replacement Volume-outcome relationship |
| title | Association between institutional case volume and mortality following thoracic aorta replacement: a nationwide Korean cohort study |
| title_full | Association between institutional case volume and mortality following thoracic aorta replacement: a nationwide Korean cohort study |
| title_fullStr | Association between institutional case volume and mortality following thoracic aorta replacement: a nationwide Korean cohort study |
| title_full_unstemmed | Association between institutional case volume and mortality following thoracic aorta replacement: a nationwide Korean cohort study |
| title_short | Association between institutional case volume and mortality following thoracic aorta replacement: a nationwide Korean cohort study |
| title_sort | association between institutional case volume and mortality following thoracic aorta replacement a nationwide korean cohort study |
| topic | Case volume Surgical prognosis Thoracic aorta replacement Volume-outcome relationship |
| url | http://link.springer.com/article/10.1186/s13019-020-01204-0 |
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