title: Acute type A aortic dissection in the United Kingdom: Surgeon volume-outcome relation.
abstract: Surgery for acute type A aortic dissection (ATAD) carries a high risk of operative mortality. We examined the surgeon volume-outcome relation with respect to in-hospital mortality for patients presenting with this pathology in the United Kingdom.
  
  
  
  Between April 2007 and March 2013, 1550 ATAD procedures were identified from the National Institute for Cardiovascular Outcomes Research database. A total of 249 responsible consultant cardiac surgeons from the United Kingdom recorded 1 or more of these procedures in their surgical activity over this period. We describe the patient population and mortality rates, focusing on the relationship between surgeon volume and in-hospital mortality.
  
  
  
  The mean annual volume of procedures per surgeon during the 6-year period ranged from 1 to 6.6. The overall in-hospital mortality rate was 18.3% (283/1550). A mortality improvement at the 95% level was observed with a risk-adjusted mean annual volume >4.5. Surgeons with a mean annual volume <4 over the study period had significantly higher in-hospital mortality rates in comparison with surgeons with a mean annual volume ≥4 (19.3% vs 12.6%; P = .015).
  
  
  
  Patients with ATAD who are operated on by lower-volume surgeons experience higher levels of in-hospital mortality. Directing these patients to higher-volume surgeons may be a strategy to reduce in-hospital mortality.
authors.affiliation: Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom. Electronic address: drmbashir@mail.com.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Bashir
authors.affiliation: Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.
authors.forename: Amer
authors.initials: A
authors.lastname: Harky
authors.affiliation: School of BUILT Environment, Liverpool John Moore University, Liverpool, United Kingdom.
authors.forename: Matthew
authors.initials: M
authors.lastname: Fok
authors.affiliation: Research and Development, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
authors.forename: Matthew
authors.initials: M
authors.lastname: Shaw
authors.affiliation: Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Academic Surgery Unit, University Hospital of South Manchester, Department of Cardiothoracic Surgery, Manchester, United Kingdom; University College London, National Institute for Cardiovascular Outcomes Research (NICOR), London, United Kingdom.
authors.forename: Graeme L
authors.initials: GL
authors.lastname: Hickey
authors.affiliation: University of Manchester, Manchester Academic Health Science Centre, Academic Surgery Unit, University Hospital of South Manchester, Department of Cardiothoracic Surgery, Manchester, United Kingdom; University College London, National Institute for Cardiovascular Outcomes Research (NICOR), London, United Kingdom; Department of Cardiothoracic Surgery, Blackpool Victoria Hospital, Blackpool, United Kingdom.
authors.forename: Stuart W
authors.initials: SW
authors.lastname: Grant
authors.affiliation: Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Uppal
authors.affiliation: Aortic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
authors.forename: Aung
authors.initials: A
authors.lastname: Oo
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D013504:Cardiovascular Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology
keywords: AAD; aneurysm; aorta; dissection; surgeon volume-outcome