Objective

Update guidelines have identified a knowledge gap with respect to the optimal management of thoracic aorta disease (TAD) and the minimum service specification for the delivery or commissioning of care for patients affected by TAD. We attempted to identify all relevant published randomized controlled trials and controlled observational (non-randomized) cohort and case-control studies evaluating the standard of care and service configuration for the management of TAD, aiming at assessing the inter

Methods

A literature search was conducted using PUBMED, Medline, Embase, Scopus and Cochrane Central register from inception through December 31, 2014. No language restrictions were applied. The relationship between provider/surgeon volume and operative outcomes were evaluated along with the influence of the teaching/non-teaching hospital status and the introduction of a defined TAD program. Three reviewers independently assessed studies for inclusions and performed data extraction.

Results

After a screening of 11,529 reports, 27 relevant articles were identified, comprising 85618 patients. High-volume hospitals revealed a significant better 30-day/in-hospital mortality compared with low-volume hospitals (OR 0.52, 95%CI 0.46-0.59) in both aneurysmatic and dissecting pathologies. The introduction of TAD program was also significant in reducing the 30-day/in-hospital mortality (OR 0.35, 95%CI 0.13-0.96), whereas the surgeon volume, teaching status or urban hospital status were not.

Conclusion

The present meta-analysis demonstrated that high-volume hospital along with specialized aortic centers attain better 30-day/in-hospital mortality for patients affected by TAD.