Smaller Hospital Size is Associated With Higher Mortality in Stanford Type A Aortic Dissection

Authors

Renxi Li, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Qianyun Luo, Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
Derrick Green, Division of Vascular Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
Stephen Huddleston, Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.

Document Type

Journal Article

Publication Date

8-26-2024

Journal

Vascular and endovascular surgery

DOI

10.1177/15385744241278839

Keywords

centralized care; hospital size; mortality; type A aortic dissection

Abstract

BACKGROUND: 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. METHOD: 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. RESULTS: 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, P < 0.01), but shorter length of stay (P < 0.01) and lower cost (P = 0.03) compared to larger hospitals. There was no difference in morbidities. CONCLUSIONS: 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.

APA Citation

Li, Renxi; Luo, Qianyun; Green, Derrick; and Huddleston, Stephen, "Smaller Hospital Size is Associated With Higher Mortality in Stanford Type A Aortic Dissection" (2024). GW Authored Works. Paper 5437.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5437

Department

School of Medicine and Health Sciences Student Works