Higher surgeon volume is associated with lower odds of complication following thoracic endovascular aortic repair for aortic dissections

Peter V Cooke; C Y Maximilian Png; Justin M George; Matthew J Eagleton; Rami O Tadros

doi:10.1016/j.jvs.2022.06.027

Higher surgeon volume is associated with lower odds of complication following thoracic endovascular aortic repair for aortic dissections

J Vasc Surg. 2022 Oct;76(4):884-890. doi: 10.1016/j.jvs.2022.06.027. Epub 2022 Jun 25.

Authors

Peter V Cooke¹, C Y Maximilian Png², Justin M George¹, Matthew J Eagleton², Rami O Tadros³

Affiliations

¹ Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
² Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA.
³ Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: rami.tadros@mountsinai.org.

PMID: 35764226
DOI: 10.1016/j.jvs.2022.06.027

Abstract

Objective: This study aimed to understand the impact of surgeon volume on outcomes of thoracic endovascular aortic repair (TEVAR) in patients being treated for aortic dissection.

Methods: Patients undergoing TEVAR from January 2014 to March 2021 in the Vascular Quality Initiative database were analyzed. Patients with aortic dissection who underwent TEVAR were divided into quartiles based on the annual TEVAR volume of their vascular surgeon. The highest quartile, middle two quartiles, and lowest quartile were deemed high volume (HV), moderate volume (MV), and low volume (LV), respectively. Multivariable logistic regressions were performed to compare cohort outcomes in terms any postoperative complication, stroke, spinal cord ischemia, reintervention, and 30-day mortality. A Cox proportional hazard model was used to assess the hazard of overall postoperative mortality.

Results: Among 1217 patients undergoing TEVAR, 321, 621, and 275 were performed by HV, MV, and LV surgeons, respectively. HV surgeons performed >19 annual TEVARs, MV surgeons between five and 18, and LV surgeons four or less. Adjusted odds of any postoperative complication revealed that HV and MV surgeons had lower odds of overall postoperative complications (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.30-0.85; P = .011 and OR, 0.60; 95% CI, 0.38-0.87; P = .008, respectively) when compared with patients of LV surgeons. Patients of HV surgeons had lower odds of respiratory complications than those of LV surgeons (OR, 0.42; 95% CI, 0.17-0.93; P = .039). Adjusted analysis of outcomes including spinal cord ischemia, stroke, myocardial infarction, 30-day mortality, and overall mortality did not reveal statistically significant differences between cohorts.

Conclusions: Surgeon volume does not to impact 30-day mortality or long-term mortality after TEVAR for aortic dissection, but the odds of overall postoperative complications were lower for HV and MV surgeons when compared with LV surgeons.

Keywords: Mortality; Postoperative complications; Spinal cord ischemia; Stroke; Surgeon volume; TEVAR.

MeSH terms

Aortic Aneurysm, Thoracic* / complications
Aortic Aneurysm, Thoracic* / diagnostic imaging
Aortic Aneurysm, Thoracic* / surgery
Aortic Dissection* / complications
Aortic Dissection* / diagnostic imaging
Aortic Dissection* / surgery
Blood Vessel Prosthesis Implantation* / adverse effects
Endovascular Procedures* / adverse effects
Humans
Postoperative Complications
Retrospective Studies
Risk Factors
Spinal Cord Ischemia* / etiology
Stroke* / etiology
Surgeons*
Treatment Outcome