The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
Vasc Endovascular Surg. 2025 Jan;59(1):5-11. doi: 10.1177/15385744241278839. Epub 2024 Aug 26.
Stanford Type A Aortic Dissection (TAAD) is associated with high in-hospital mortality and the need for immediate surgical intervention. Larger hospital size may be associated with better patient care and surgical outcomes. This study aimed to examine the effect of hospital size on TAAD outcomes.
Patients who underwent TAAD repair were identified in National Inpatient Sample (NIS) from Q4 2015-2020. NIS stratifies hospital size into small, medium, and large based on the number of hospital beds, geographical location, and the teaching status of the hospitals. Patients admitted to small/medium and large hospitals were stratified into two cohorts. Multivariable logistic regressions were performed to compare in-hospital outcomes, adjusted for demographics, comorbidity, primary payer status, and hospital characteristics including procedural volume.
There were 1106 and 3752 TAAD admitted to small/medium and large hospitals, respectively. Among patients admitted to small/medium hospitals, there was higher mortality (17.27% vs 14.37%, aOR = 1.32, < 0.01), but shorter length of stay ( < 0.01) and lower cost ( = 0.03) compared to larger hospitals. There was no difference in morbidities.
Marked higher mortality is associated with admission to smaller hospitals among patients with TAAD, which may in turn decrease the average hospital stay and cost. Given that a significant percentage of patients are already being transferred out of the initial hospital and small/medium hospital is associated with higher mortality, centralization of care in centers of excellence may decrease the high mortality associated with TAAD.
斯坦福 A 型主动脉夹层（TAAD）与院内高死亡率和立即手术干预相关。较大的医院规模可能与更好的患者护理和手术结果相关。本研究旨在探讨医院规模对 TAAD 结果的影响。
在 2015 年第四季度至 2020 年期间，从国家住院患者样本（NIS）中确定接受 TAAD 修复的患者。NIS 根据医院病床数量、地理位置和医院教学状况将医院规模分为小、中、大三种类型。将入住小/中型和大型医院的患者分为两个队列。采用多变量逻辑回归比较院内结果，调整了人口统计学、合并症、主要支付者状态和包括手术量在内的医院特征。
分别有 1106 名和 3752 名 TAAD 患者入住小/中型和大型医院。在入住小/中型医院的患者中，死亡率较高（17.27% vs 14.37%，aOR=1.32， < 0.01），但住院时间较短（ < 0.01）且费用较低（ = 0.03）。发病率无差异。
与较大型医院相比，TAAD 患者入住较小型医院与死亡率显著升高相关，这可能反过来降低平均住院时间和费用。鉴于相当一部分患者已经从初始医院转出，小/中型医院与更高的死亡率相关，因此在卓越中心集中治疗可能会降低 TAAD 相关的高死亡率。
