부산대학교 도서관

Introduction: Aortic dissection (AD) repair is a high-risk procedure. Hospital teaching status may impact postoperative outcomes after AD repair. This study aimed to compare mortality after AD repair for both Stanford Type A (TAAD) and Stanford Type B (TBAD) in urban private practice (UPP) versus teaching hospitals (TH). Method: Patients who underwent TAAD and TBAD repair were identified in the National Inpatient Sample (NIS) from Q4 2015-2020 by ICD10-CM/PCS. Comparison of postoperative mortality between UPP versus TH among TAAD and TBAD were examined separately. In addition, mortality after open surgery and Thoracic Endovascular Aneurysm Repair (TEVAR) in TBAD were compared. Significant preoperative differences were present between cohorts, so multivariable logistic regressions were performed. Adjusted preoperative variables included sex, age, race, socioeconomic status, comorbidity, primary payer status, and hospital characteristics. Result: There were 316 patients in UPP and 4,494 patients in TH who underwent TAAD repair. In TBAD, 247 patients were treated in UPP and 3,845 patients were treated in TH. Of patients with TBAD, 114 UPP and 1,533 TH had open repair, whereas 133 UPP and 2,312 TH had TEVAR. Compared to TH, mortality was higher in both TAAD (aOR 1.37, p<0.01) and TBAD (aOR 1.89, p<0.01) in UPP. Within TBAD, UPP had higher mortality in both open repair (aOR 1.80, p<0.02) and TEVAR (aOR 1.88, p<0.05). At UPP, length of stay>7 days was less common than in TH (aOR 0.50, p<0.01) among patients who had TBAD open repair. Post-operative major adverse cardiac events, myocardial infarction, or stroke were not different in all AD groups when comparing patients in UPP to TH.Conclusion: Treatment of both TAAD and TBAD at UPP is associated with significantly higher in-hospital mortality. Emergent transfer to teaching hospitals might be considered to achieve lower mortality of AD.