Background: Despite recent advances, reported mortality rates after repair for acute type A aortic dissection vary from 5% to 30%. This study was conducted to assess cross-sectional mortality after operative repair of type A dissection in the United States, and to determine whether a volume-outcome relationship exists for this operative procedure.
Methods: Data were obtained from the Nationwide Inpatient Sample, which is a cross-sectional administrative database incorporating 20% of all annual US hospital discharges. From 1995 to 2003, a cohort of 3013 patients with thoracic or thoracoabdominal dissection who underwent aortic resection was identified. Patient demographics, hospital volumes, and teaching status were included as independent variables.
Results: The mean age was 62 +/- 14 years (65% male). In-hospital mortality for the study period was 26%, but it decreased from 27% in 1995 to 23% in 2003 (P = .03). A significant correlation was found between procedural volume and mortality (P < .001). By multivariate analysis, independent predictors of mortality included increasing age (P < .0001) and operation at a non-teaching hospital (P = .002).
Conclusions: Operative mortality for repair of ascending aortic dissection in the United States has shown modest temporal improvements. More importantly, operative mortality seems to be dependent on the arena of care.