Objective

The optimal service configuration for management of patients affected by thoracic aortic disease (TAD) has not been defined. Across centres and regions a wide variation in treatment and outcomes has been reported, and recent evidences recommend that TAD may benefit from high-volume surgical centres with focused aortic multidisciplinary expertise. The present study aims to identify if is the hospital-volume or the distal aortic segment influencing the outcomes of patients treated because of TAD.

Methods

Prospectively collected data were extracted from NICOR’s NACSA database (version 4.1.2) for all adult thoracic aortic procedures performed in England between the 1st of April 2007 and the 31st of March 2013. We examined the in-hospital mortality and assessed the relationship between volume (terciles of total performed cases) and treated aortic segments (root/ascending aorta vs aortic arch vs descending thoracic aorta vs thoraco-abdominal aorta [TAAA]) to operative outcomes.

Results

A total of 8058 patients with TAD were identified: aneurysms (54.9%) and dissections (22.6%). 85% of cases were root/ascending, aortic arch in 9.5%, descending aorta in 4%, and TAAA in 1.5%. Low-volume centres performed 893 cases, medium-volume (MV) 2283, and high-volume (HV) 4882. At multivariate level, in-hospital mortality was significantly influenced by the distal aortic segment only, but not by hospital volume activity (HV and MV centres: OR 0.85, 95%CI 0.65-1.11; and OR 0.89, 0.66-1.18).

Conclusion

Hospital volume does not influence in-hospital mortality, but the complexity of the treated aortic segments. Concentrating surgery for the most distal aortic segments in specific centres is a strategy to reduce operative mortality. Root/ascending surgery can be performed with satisfactory results in all centres independently from the thoracic aortic pathology.