Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Ann Thorac Surg. 2023 Oct;116(4):721-727. doi: 10.1016/j.athoracsur.2022.05.018. Epub 2022 May 26.
The purpose of this study was to assess the effect of a hospital's teaching status on survival and outcomes of patients presenting with type A aortic dissections imperative for enhancing patient care.
The National Readmission Database was used to review all type A aortic dissections between 2010 and 2017. Provided sampling weights were used to generate national estimates, and baseline variables were compared with descriptive statistics. Mixed effects and logistic models were created for 30-day and 90-day readmission and inhospital mortality.
In all, 37 396 type A aortic dissections were identified, the majority of which (83%) were operated on at a teaching hospital. Inhospital mortality was higher at nonteaching hospitals A (20.3% vs 14.42%, P < .001). Median hospital charge was higher at teaching hospitals ($59 670 vs $53 220, P < .001). There was a higher rate of 30-day readmission in teaching hospitals (20.95% vs 19.36%, P = .02). On logistic regression for mortality, hospital teaching status was a significant protective factor (odds ratio 0.83, P < .001). On mixed effects logistic regression, hospital teaching status was not significant for readmissions.
Type A aortic dissections continue to be primarily managed by teaching hospitals, with superior outcomes continuing to come from teaching hospitals. Given the substantial proportion of patients presenting out of state, investigations into optimal patient transfer and postoperative monitoring and referral could improve care.
本研究旨在评估医院的教学地位对 A 型主动脉夹层患者生存和结局的影响，以提高患者的护理水平。
本研究使用国家再入院数据库回顾了 2010 年至 2017 年间所有 A 型主动脉夹层患者。采用提供的抽样权重生成全国估计值，并使用描述性统计比较基线变量。采用混合效应和逻辑回归模型评估 30 天和 90 天再入院率和院内死亡率。
共纳入 37396 例 A 型主动脉夹层患者，其中大多数（83%）在教学医院接受手术治疗。非教学医院的院内死亡率更高（20.3% vs 14.42%，P <.001）。教学医院的平均住院费用更高（$59670 美元 vs $53220 美元，P <.001）。教学医院的 30 天再入院率更高（20.95% vs 19.36%，P =.02）。在死亡率的逻辑回归中，医院的教学地位是一个显著的保护因素（比值比 0.83，P <.001）。在混合效应逻辑回归中，医院的教学地位与再入院率无关。
A 型主动脉夹层主要由教学医院管理，教学医院的治疗效果仍然更好。鉴于大量患者来自州外，对最佳患者转移、术后监测和转诊的研究可以改善护理。
