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Aortic centres should represent the standard of care for acute aortic syndrome

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)3-14
Number of pages12
JournalEuropean Journal of Preventive Cardiology
Volume25
Issue number1_suppl
Early online date30 Apr 2018
DOIs
DateAccepted/In press - 22 Feb 2018
DateE-pub ahead of print - 30 Apr 2018
DatePublished (current) - 1 Jun 2018

Abstract

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.

    Research areas

  • Acute aortic syndrome, aortic dissections, hospital volume, meta-analysis, quality of health care, surgeon volume

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    Rights statement: This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Sage at https://journals.sagepub.com/doi/10.1177/2047487318764963 . Please refer to any applicable terms of use of the publisher.

    Accepted author manuscript, 398 KB, PDF document

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