Ahmad Danial, Sá Michel Pompeu, Brown James A, Yousef Sarah, Wang Yisi, Serna-Gallegos Derek, West David, Yoon Pyongsoo, Kaczorowski David, Bonatti Johannes, Chu Danny, Ferdinand Francis D, Phillippi Julie, Sultan Ibrahim
Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
J Cardiothorac Vasc Anesth. 2025 Jan;39(1):88-94. doi: 10.1053/j.jvca.2024.10.039. Epub 2024 Oct 28.
To assess the association of hospital teaching status with outcomes of patients presenting with type B aortic dissection (TBAD).
Retrospective cross-sectional study of the National Readmissions Database (NRD), from 2016 to 2020.
Hospitals across the United States stratified by teaching status.
TBAD patients.
Surgical repair, thoracic endovascular aortic repair (TEVAR), and conservative medical management.
A total of 44,981 TBAD patients were included, of whom 5421 (12%) were managed at a nonteaching (NT) hospital and 39,470 (88%) were treated at a teaching (T) hospital. Propensity score matching (1:1) yielded 4676 matched pairs. In-hospital mortality (12.9% for NT vs 12.5% for T; p = 0.58) and 30-day readmission (23.3% for NT vs 21.8% for T; p = 0.12) outcomes were not statistically significantly different between the groups. On multivariable regression, teaching status was not associated with higher odds of in-hospital mortality (odds ratio [OR], 0.943; 95% confidence interval [CI, 0.841-1.057; p = 0.31) or 30-day readmission (OR, 0.965; 95% CI, 0.88-1.058; p = 0.44). At teaching hospitals, TEVAR was associated with higher odds of in-hospital mortality (OR, 1.898; 95% CI, 1.596-2.257; p < .01), while hospital volume was associated with higher odds of 30-day readmission (quartile 3: OR, 1.488; 95% CI, 1.106-2.002; quartile 4: OR, 1.684; 95% CI, 1.256-2.257; p < 0.01).
Hospital teaching status alone was not associated with in-hospital mortality or 30-day readmission in TBAD patients. At teaching hospitals, management by TEVAR and greater hospital volume were associated with in-hospital mortality and 30-day readmission outcome, respectively.
评估医院教学状况与B型主动脉夹层（TBAD）患者治疗结果之间的关联。
对2016年至2020年国家再入院数据库（NRD）进行回顾性横断面研究。
美国各地的医院按教学状况分层。
TBAD患者。
手术修复、胸主动脉腔内修复术（TEVAR）和保守药物治疗。
共纳入44981例TBAD患者，其中5421例（12%）在非教学医院接受治疗，39470例（88%）在教学医院接受治疗。倾向评分匹配（1:1）产生了4676对匹配病例。两组间的住院死亡率（非教学医院为12.9%，教学医院为12.5%；p = 0.58）和30天再入院率（非教学医院为23.3%，教学医院为21.8%；p = 0.12）在统计学上无显著差异。多变量回归分析显示，教学状况与住院死亡率增加的几率无关（比值比[OR]，0.943；95%置信区间[CI]，0.841 - 1.057；p = 0.31），也与30天再入院率无关（OR，0.965；95% CI，0.88 - 1.058；p = 0.44）。在教学医院，TEVAR与住院死亡率增加的几率相关（OR，1.898；95% CI，1.596 - 2.257；p < 0.01），而医院规模与30天再入院率增加的几率相关（第3四分位数：OR，1.488；95% CI，1.106 - 2.002；第4四分位数：OR，1.684；95% CI，1.256 - 2.257；p < 0.
