title: Elective thoracic aortic aneurysm surgery: better outcomes from high-volume centers.
abstract: BACKGROUND
  Although studies have demonstrated clinical advantages in high-volume (HV) centers performing esophageal and pancreatic resections, thoracic aortic aneurysm repair has not been studied in the same fashion. We sought to determine if HV centers have better outcomes after thoracic aortic aneurysm surgery relative to lower-volume (LV) centers.
  
  
  METHODS
  Retrospective review of prospectively collected data pooled from the 17 institutions participating in the Virginia Cardiac Surgery Quality Initiative (VCSQI) database was performed during a 3-year period. LV centers were those that performed <40 operations during the study period, and HV centers were those that performed >80 operations. Preoperative risk factors and outcomes were compared between the 2 groups. Multivariate analysis was performed to evaluate the impact of center volume on mortality. Only elective operations were studied.
  
  
  RESULTS
  HV centers performed 515 operations during the study period compared with 216 operations from LV centers. Perioperative mortality was significantly lower in HV centers (3.7%, n = 19) versus LV centers (8.3%, n = 18) (p = 0.02). Incidence of renal failure (HV: 4.5%; LV: 8.3%; p = 0.05) and prolonged ventilator course (HV: 16.7%; LV: 25.5%; p = 0.01) were also lower in the HV centers relative to LV centers. HV centers had higher stroke rates compared with LV centers (HV: 4.8%, LV: 1.4%; p < 0.01). Total hospital cost was $42,736 in HV centers and $51,296 in LV centers (p = 0.04). On regression analysis, LV centers were significantly associated with increased complications and mortality (all p < 0.05).
  
  
  CONCLUSIONS
  Although LV centers had lower stroke rates, HV centers had overall better outcomes, lower mortality rates, and considerably lower cost compared with LV centers.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Leo M
authors.initials: LM
authors.lastname: Gazoni
authors.forename: Alan M
authors.initials: AM
authors.lastname: Speir
authors.forename: Irving L
authors.initials: IL
authors.lastname: Kron
authors.forename: Edward
authors.initials: E
authors.lastname: Fonner
authors.forename: Ivan K
authors.initials: IK
authors.lastname: Crosby
mesh_terms: D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*