Hospital volume and outcomes of surgical repair in type A acute aortic dissection: A nationwide cohort study

Iván Alejandro De León Ayala; Feng Cheng Chang; Chun Yu Chen; Yu Ting Cheng; Yi Hsin Chan; Victor Chien Chia Wu; Kuo Sheng Liu; Chi Hsiao Yeh; Pao Hsien Chu; Shao Wei Chen

doi:10.1371/journal.pone.0325689

Hospital volume and outcomes of surgical repair in type A acute aortic dissection: A nationwide cohort study

Iván Alejandro De León Ayala, Feng Cheng Chang, Chun Yu Chen, Yu Ting Cheng, Yi Hsin Chan, Victor Chien Chia Wu, Kuo Sheng Liu, Chi Hsiao Yeh, Pao Hsien Chu, Shao Wei Chen^*

^*Corresponding author for this work

School of Traditional Chinese Medicine

Research output: Contribution to journal › Journal Article › peer-review

Abstract

BACKGROUND: Over the last decade, the number of patients treated with open repair for TAAAD in Taiwan has dramatically increased. This study aims to assess the hospital-volume relationship with surgical outcomes of type A acute aortic dissection (TAAAD) across hospitals in Taiwan.

METHODS: Using the Taiwan National Health Insurance (NHI) Research Database (NHIRD), we include only the patients who underwent first open repair for TAAAD from 01/01/2005, to 31/12/2020, in Taiwan. A total of 8,059 patients in 77 hospitals were eligible for the analysis. Hospitals were categorized based on their 16-year cumulative volume of TAAAD open repair surgeries, and patients were grouped into quartiles accordingly.

RESULTS: Ascending aortic replacement (55.7%) and partial/total arch replacement (38.8%) were the most common methods of open aortic repair. In-hospital mortality was 22% and decreased from 28% in 2005 to 20% in 2020. Greater volume (per 5 annual surgeries) was associated with lower risks of in-hospital mortality (odd ratio 0.90, 95% confidence interval [CI] 0.87-0.92) and mortality after discharge (hazard ratio 0.97, 95% CI 0.95-0.99).

CONCLUSION: Operative volume inversely correlates to in-hospital mortality and postoperative complications. The volume-outcome effect extends after discharge and reflects better long-term survival. Hospital referral to high-volume centers should be considered in patients needing complex open repair for TAAAD.

Original language	English
Article number	e0325689
Pages (from-to)	e0325689
Journal	PLoS ONE
Volume	20
Issue number	6
DOIs	https://doi.org/10.1371/journal.pone.0325689
State	Published - 06 2025

Bibliographical note

Copyright: © 2025 De León Ayala et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Keywords

Humans
Male
Female
Aortic Dissection/surgery
Middle Aged
Hospital Mortality
Aged
Taiwan/epidemiology
Treatment Outcome
Hospitals, High-Volume/statistics & numerical data
Cohort Studies
Aortic Aneurysm, Thoracic/surgery
Acute Disease

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title = "Hospital volume and outcomes of surgical repair in type A acute aortic dissection: A nationwide cohort study",

abstract = "BACKGROUND: Over the last decade, the number of patients treated with open repair for TAAAD in Taiwan has dramatically increased. This study aims to assess the hospital-volume relationship with surgical outcomes of type A acute aortic dissection (TAAAD) across hospitals in Taiwan.METHODS: Using the Taiwan National Health Insurance (NHI) Research Database (NHIRD), we include only the patients who underwent first open repair for TAAAD from 01/01/2005, to 31/12/2020, in Taiwan. A total of 8,059 patients in 77 hospitals were eligible for the analysis. Hospitals were categorized based on their 16-year cumulative volume of TAAAD open repair surgeries, and patients were grouped into quartiles accordingly.RESULTS: Ascending aortic replacement (55.7\%) and partial/total arch replacement (38.8\%) were the most common methods of open aortic repair. In-hospital mortality was 22\% and decreased from 28\% in 2005 to 20\% in 2020. Greater volume (per 5 annual surgeries) was associated with lower risks of in-hospital mortality (odd ratio 0.90, 95\% confidence interval [CI] 0.87-0.92) and mortality after discharge (hazard ratio 0.97, 95\% CI 0.95-0.99).CONCLUSION: Operative volume inversely correlates to in-hospital mortality and postoperative complications. The volume-outcome effect extends after discharge and reflects better long-term survival. Hospital referral to high-volume centers should be considered in patients needing complex open repair for TAAAD.",

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author = "\{De Le{\'o}n Ayala\}, \{Iv{\'a}n Alejandro\} and Chang, \{Feng Cheng\} and Chen, \{Chun Yu\} and Cheng, \{Yu Ting\} and Chan, \{Yi Hsin\} and Wu, \{Victor Chien Chia\} and Liu, \{Kuo Sheng\} and Yeh, \{Chi Hsiao\} and Chu, \{Pao Hsien\} and Chen, \{Shao Wei\}",

note = "Copyright: {\textcopyright} 2025 De Le{\'o}n Ayala et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2025",

month = jun,

doi = "10.1371/journal.pone.0325689",

language = "英语",

volume = "20",

pages = "e0325689",

journal = "PLoS ONE",

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TY - JOUR

T1 - Hospital volume and outcomes of surgical repair in type A acute aortic dissection

T2 - A nationwide cohort study

AU - De León Ayala, Iván Alejandro

AU - Chang, Feng Cheng

AU - Chen, Chun Yu

AU - Cheng, Yu Ting

AU - Chan, Yi Hsin

AU - Wu, Victor Chien Chia

AU - Liu, Kuo Sheng

AU - Yeh, Chi Hsiao

AU - Chu, Pao Hsien

AU - Chen, Shao Wei

N1 - Copyright: © 2025 De León Ayala et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2025/6

Y1 - 2025/6

N2 - BACKGROUND: Over the last decade, the number of patients treated with open repair for TAAAD in Taiwan has dramatically increased. This study aims to assess the hospital-volume relationship with surgical outcomes of type A acute aortic dissection (TAAAD) across hospitals in Taiwan.METHODS: Using the Taiwan National Health Insurance (NHI) Research Database (NHIRD), we include only the patients who underwent first open repair for TAAAD from 01/01/2005, to 31/12/2020, in Taiwan. A total of 8,059 patients in 77 hospitals were eligible for the analysis. Hospitals were categorized based on their 16-year cumulative volume of TAAAD open repair surgeries, and patients were grouped into quartiles accordingly.RESULTS: Ascending aortic replacement (55.7%) and partial/total arch replacement (38.8%) were the most common methods of open aortic repair. In-hospital mortality was 22% and decreased from 28% in 2005 to 20% in 2020. Greater volume (per 5 annual surgeries) was associated with lower risks of in-hospital mortality (odd ratio 0.90, 95% confidence interval [CI] 0.87-0.92) and mortality after discharge (hazard ratio 0.97, 95% CI 0.95-0.99).CONCLUSION: Operative volume inversely correlates to in-hospital mortality and postoperative complications. The volume-outcome effect extends after discharge and reflects better long-term survival. Hospital referral to high-volume centers should be considered in patients needing complex open repair for TAAAD.

AB - BACKGROUND: Over the last decade, the number of patients treated with open repair for TAAAD in Taiwan has dramatically increased. This study aims to assess the hospital-volume relationship with surgical outcomes of type A acute aortic dissection (TAAAD) across hospitals in Taiwan.METHODS: Using the Taiwan National Health Insurance (NHI) Research Database (NHIRD), we include only the patients who underwent first open repair for TAAAD from 01/01/2005, to 31/12/2020, in Taiwan. A total of 8,059 patients in 77 hospitals were eligible for the analysis. Hospitals were categorized based on their 16-year cumulative volume of TAAAD open repair surgeries, and patients were grouped into quartiles accordingly.RESULTS: Ascending aortic replacement (55.7%) and partial/total arch replacement (38.8%) were the most common methods of open aortic repair. In-hospital mortality was 22% and decreased from 28% in 2005 to 20% in 2020. Greater volume (per 5 annual surgeries) was associated with lower risks of in-hospital mortality (odd ratio 0.90, 95% confidence interval [CI] 0.87-0.92) and mortality after discharge (hazard ratio 0.97, 95% CI 0.95-0.99).CONCLUSION: Operative volume inversely correlates to in-hospital mortality and postoperative complications. The volume-outcome effect extends after discharge and reflects better long-term survival. Hospital referral to high-volume centers should be considered in patients needing complex open repair for TAAAD.

KW - Humans

KW - Male

KW - Female

KW - Aortic Dissection/surgery

KW - Middle Aged

KW - Hospital Mortality

KW - Aged

KW - Taiwan/epidemiology

KW - Treatment Outcome

KW - Hospitals, High-Volume/statistics & numerical data

KW - Cohort Studies

KW - Aortic Aneurysm, Thoracic/surgery

KW - Acute Disease

UR - https://www.scopus.com/pages/publications/105007979570

U2 - 10.1371/journal.pone.0325689

DO - 10.1371/journal.pone.0325689

M3 - 文章

C2 - 40493624

AN - SCOPUS:105007979570

SN - 1932-6203

VL - 20

SP - e0325689

JO - PLoS ONE

JF - PLoS ONE

IS - 6

M1 - e0325689

ER -

Hospital volume and outcomes of surgical repair in type A acute aortic dissection: A nationwide cohort study

Abstract

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Keywords

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