title: Aortic Center: specialized care improves outcomes and decreases mortality.
abstract: OBJECTIVE
  To compare in-hospital outcomes in aortic surgery in our cardiac surgery unit, before and after foundation of our Center for Aortic Surgery (CTA).
  
  
  METHODS
  Prospective cohort with non-concurrent control. Foundation of CTA required specialized training of surgical, anesthetic and intensive care unit teams, routine neurological monitoring, endovascular and hybrid facilities, training of the support personnel, improvement of the registry and adoption of specific protocols. We included 332 patients operated on between: January/2003 to December/2007 (before-CTA, n=157, 47.3%); and January/2008 to December/2010 (CTA, n=175, 52.7%). Baseline clinical and demographic data, operative variables, complications and in-hospital mortality were compared between both groups.
  
  
  RESULTS
  Mean age was 58±14 years, with 65% male. Group CTA was older, had higher rate of diabetes, lower rates of COPD and HF, more non-urgent surgeries, endovascular procedures, and aneurysms. In the univariate analysis, CTA had lower mortality (9.7 vs. 23.0%, P=0.008), which occurred consistently across different diseases and procedures. Other outcomes which were reduced in CTA included lower rates of reinterventions (5.7 vs 11%, P=0.046), major complications (20.6 vs. 33.1%, P=0.007), stroke (4.6 vs. 10.9%, P=0.045) and sepsis (1.7 vs. 9.6%, P=0.001), as compared to before-CTA. Multivariable analysis adjusted for potential confounders revealed that CTA was independently associated with mortality reduction (OR=0.23, IC 95% 0.08 - 0.67, P=0.007). CTA independent mortality reduction was consistent in the multivariable analysis stratified by disease (aneurysm, OR=0.18, CI 95% 0.03 - 0.98, P=0.048; dissection, OR=0.31, CI 95% 0.09 - 0.99, P=0.049) and by procedure (hybrid, OR=0.07, CI 95% 0.007 - 0.72, P=0.026; Bentall, OR=0.18, CI 95% 0.038 - 0.904, P=0.037). Additional multivariable predictors of in-hospital mortality included creatinine (OR=1.7 [1.1-2.6], P=0.008), urgent surgery (OR=5.0 [1.5-16.7], P=0.008) and thoracoabdominal aneurysm (OR=24.6 [3.1-194.1], P=0.002).
  
  
  CONCLUSIONS
  Thoracic aorta surgery in specialized center was associated with lower incidence of complications and all-cause mortality as compared to usual care.
authors.affiliation: Cardiovascular Surgery Division, Hospital São Francisco, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Marcela da Cunha
authors.initials: Mda C
authors.lastname: Sales
authors.affiliation: Cardiovascular Surgery Division, Hospital São Francisco, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: José Dario
authors.initials: JD
authors.lastname: Frota Filho
authors.affiliation: Cardiovascular Surgery Division, Hospital São Francisco, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Cristiane
authors.initials: C
authors.lastname: Aguzzoli
authors.affiliation: Cardiovascular Surgery Division, Hospital São Francisco, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Leonardo Dornelles
authors.initials: LD
authors.lastname: Souza
authors.affiliation: Cardiovascular Surgery Division, Hospital São Francisco, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Álvaro Machado
authors.initials: ÁM
authors.lastname: Rösler
authors.affiliation: Cardiovascular Surgery Division, Hospital São Francisco, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Eraldo Azevedo
authors.initials: EA
authors.lastname: Lucio
authors.affiliation: Cardiovascular Surgery Division, Hospital São Francisco, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Paulo Ernesto
authors.initials: PE
authors.lastname: Leães
authors.affiliation: Cardiovascular Surgery Division, Hospital São Francisco, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Mauro Ricardo Nunes
authors.initials: MR
authors.lastname: Pontes
authors.affiliation: Cardiovascular Surgery Division, Hospital São Francisco, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Fernando Antônio
authors.initials: FA
authors.lastname: Lucchese
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000601:surgery*; D001018:Aortic Diseases / Q000401:mortality* / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality; D057510:Endovascular Procedures / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D017052:Hospital Mortality; D006782:Hospitals, Special / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D016896:Treatment Outcome