Aortic & peripheral vascular diseaseMeta-analysis
Type A aortic dissection: optimal annual case volume for surgery
- Systematic review and meta-analysis
- volume-outcome meta-analysis
- restricted cubic splines
- elbow method
Authors' conclusion
Using this novel approach, the optimal hospital case volume threshold was statistically determined. Centralization of ATAAD care to high-volume centres may lead to improved outcomes.
Study context
- Population
- Patients undergoing surgery for acute type A aortic dissection (ATAAD)
- Participants
- 38,276 patients · 140 studies
- Comparison
- Annual hospital case volume quartiles
- Outcome
- Early mortality in relation to annual hospital case volume
Pooled result
As reported in the abstract
Early mortality
- Significant non-linear volume-outcome effect
- P < 0.001
- Optimal annual case volume
- 38 cases/year (95% CI 37-40 cases/year)
- NNT to save a life, optimal volume vs 10 cases/year
- 21
Further pooled results
| Outcome | Q4 | Q1 | adjusted HR (95% CI) | P value | |
|---|---|---|---|---|---|
| 10-year survival · per quartile; NNT Q4 vs Q1 = 6 | 69% | 51% | 0.83 (0.75–0.91) | P < 0.01 | |
| 0.512Adjusted hazard ratio (log scale) |
Original publication
Type A aortic dissection: optimal annual case volume for surgery. Eur Heart J. Published 28 August 2023. doi:10.1093/eurheartj/ehad551
Summarised from the published abstract; every number is checked against it