TY - JOUR
T1 - Aortic centres should represent the standard of care for acute aortic syndrome
AU - Mariscalco, Giovanni
AU - Maselli, Daniele
AU - Zanobini, Marco
AU - Ahmed, Aamer
AU - Bruno, Vito D.
AU - Benedetto, Umberto
AU - Gherli, Riccardo
AU - Gherli, Tiziano
AU - Nicolini, Francesco
PY - 2018/6/1
Y1 - 2018/6/1
N2 - Background: Existing evidence suggests that patients affected by acute aortic syndromes (AAS) may benefit from treatment at dedicated specialized aortic centres. The purpose of the present study was to perform a meta-analysis to evaluate the impact aortic service configuration has in clinical outcomes in AAS patients. Methods: The design was a quantitative and qualitative review of observational studies. We searched PubMed/MEDLINE, EMBASE, and Cochrane Library from inception to the end of December 2017 to identify eligible articles. Areas of interest included hospital and surgeon volume activity, presence of a multidisciplinary thoracic aortic surgery program, and a dedicated on-call aortic team. Participants were patients undergoing repair for AAS, and odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were adopted for synthesizing hospital/30-day mortality. Results: A total of 79,131 adult patients from a total of 30 studies were obtained. No randomized studies were identified. Pooled unadjusted ORs showed that patients treated in high-volume centres or by high-volume surgeons were associated with lower mortality rates (OR 0.51; 95% CI 0.46–0.56, and OR 0.41, 95% CI 0.25–0.66, respectively). Pooled adjusted estimates for both high-volume centres and surgeons confirmed these survival benefits (adjusted OR, 0.56; 95% CI 0.45–0.70, respectively). Patients treated in centres that introduced a specific multidisciplinary aortic program and a dedicated on-call aortic team also showed a significant reduction in mortality (OR 0.31; 95% CI 0.19–0.5, and OR 0.37; 95% CI 0.15–0.87, respectively). Conclusions: We found that specialist aortic care improves outcomes and decreases mortality in patients affected by AAS.
AB - Background: Existing evidence suggests that patients affected by acute aortic syndromes (AAS) may benefit from treatment at dedicated specialized aortic centres. The purpose of the present study was to perform a meta-analysis to evaluate the impact aortic service configuration has in clinical outcomes in AAS patients. Methods: The design was a quantitative and qualitative review of observational studies. We searched PubMed/MEDLINE, EMBASE, and Cochrane Library from inception to the end of December 2017 to identify eligible articles. Areas of interest included hospital and surgeon volume activity, presence of a multidisciplinary thoracic aortic surgery program, and a dedicated on-call aortic team. Participants were patients undergoing repair for AAS, and odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were adopted for synthesizing hospital/30-day mortality. Results: A total of 79,131 adult patients from a total of 30 studies were obtained. No randomized studies were identified. Pooled unadjusted ORs showed that patients treated in high-volume centres or by high-volume surgeons were associated with lower mortality rates (OR 0.51; 95% CI 0.46–0.56, and OR 0.41, 95% CI 0.25–0.66, respectively). Pooled adjusted estimates for both high-volume centres and surgeons confirmed these survival benefits (adjusted OR, 0.56; 95% CI 0.45–0.70, respectively). Patients treated in centres that introduced a specific multidisciplinary aortic program and a dedicated on-call aortic team also showed a significant reduction in mortality (OR 0.31; 95% CI 0.19–0.5, and OR 0.37; 95% CI 0.15–0.87, respectively). Conclusions: We found that specialist aortic care improves outcomes and decreases mortality in patients affected by AAS.
KW - Acute aortic syndrome
KW - aortic dissections
KW - hospital volume
KW - meta-analysis
KW - quality of health care
KW - surgeon volume
UR - http://www.scopus.com/inward/record.url?scp=85046816342&partnerID=8YFLogxK
U2 - 10.1177/2047487318764963
DO - 10.1177/2047487318764963
M3 - Article (Academic Journal)
C2 - 29708034
AN - SCOPUS:85046816342
VL - 25
SP - 3
EP - 14
JO - European Journal of Preventive Cardiology
JF - European Journal of Preventive Cardiology
SN - 2047-4873
IS - 1_suppl
ER -