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    Clinical Practice Variation and Outcomes for Stanford Type A Aortic Dissection Repair Surgery in Maryland: Report from a Statewide Quality Initiative

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    Author
    Mazzeffi, Michael
    Ghoreishi, Mehrdad
    Alejo, Diane
    Fonner, Clifford E
    Tanaka, Kenichi
    Abernathy, James H
    Whitman, Glenn
    Salenger, Rawn
    Lawton, Jennifer
    Ad, Niv
    Brown, James
    Gammie, James
    Taylor, Bradley
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    Date
    2020-11-05
    Journal
    Aorta (Stamford, Conn.)
    Publisher
    Thieme Medical Publishers, Inc.
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1055/s-0040-1714121
    Abstract
     A total of 233 patients were included from eight hospitals during the study period. Seventy-six percent of surgeries were done in two high-volume hospitals (≥10 cases per year), while the remaining 24% were done in low-volume hospitals. Operative mortality was 12.0% and varied between 0 and 25.0% depending on the hospital. Variables that differed significantly between hospitals included patient age, the percentage of patients in shock, left ventricular ejection fraction, creatinine level, arterial cannulation site, brain protection technique, tobacco use, and intraoperative blood transfusion. The percentage of patients who underwent aortic valve repair or replacement procedures differed significantly between hospitals (p < 0.001), although the prevalence of moderate-to-severe aortic insufficiency was not significantly different (p = 0.14). There were no significant differences in clinical outcomes including mortality, renal failure, stroke, or gastrointestinal complications between hospitals or based on arterial cannulation site (all p > 0.05). Patients who had aortic cross-clamping or endovascualr repair had more embolic strokes when compared with patients who had hypothermic circulatory arrest (p = 0.03).
    Rights/Terms
    The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
    Keyword
    Aneurysm, Dissecting--surgery
    Aorta
    Outcome Assessment, Health Care
    Maryland
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/14836
    ae974a485f413a2113503eed53cd6c53
    10.1055/s-0040-1714121
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