Impact Of Hospital Teaching Status On Outcomes In Type B Aortic Dissection: Analysis of 40,000 Patients

P0155 

Abstract Submission 

Danial Ahmad (1), James Brown (1), Sarah Yousef (2), Derek Serna-Gallegos (3), Yisi Wang (1), David West (1), Pyongsoo Yoon (1), David Kaczorowski (4), Johannes Bonatti (5), Danny Chu (6), Francis Ferdinand (7), Julie Phillippi (8), Ibrahim Sultan (3)

(1) UPMC, Pittsburgh, PA, (2) University of Pittsburgh, Pittsburgh, PA, (3) University of Pittsburgh Medical Center, Pittsburgh, PA, (4) University of Pittsburgh Medical Center, Venetia, PA, (5) UPMC Heart and Vascular Institute, Pittsburgh, PA, (6) Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, (7) UPMC, Erie, PA, (8) N/A, Pittsburgh, PA

Danial Ahmad    -  Contact Me
UPMC

James Brown    -  Contact Me
UPMC

Sarah Yousef    -  Contact Me
University of Pittsburgh

Derek Serna-Gallegos    -  Contact Me
University of Pittsburgh Medical Center

Yisi Wang    -  Contact Me
UPMC

David West    -  Contact Me
UPMC

Pyongsoo Yoon    -  Contact Me
UPMC

*David Kaczorowski    -  Contact Me
University of Pittsburgh Medical Center

♦Johannes Bonatti    -  Contact Me
UPMC Heart and Vascular Institute

*Danny Chu    -  Contact Me
Veterans Affairs Pittsburgh Healthcare System

Francis Ferdinand    -  Contact Me
UPMC

*Julie Phillippi    -  Contact Me
N/A

*Ibrahim Sultan    -  Contact Me
University of Pittsburgh Medical Center

Danial Ahmad    -  Contact Me
UPMC

Objectives:
In this study, we sought to assess the impact of a hospital's teaching status on survival and outcomes of patients presenting with type B aortic dissections (TBAD) across the United States. Additionally, we attempted to assess whether patient outcomes differed by TBAD management strategy.
Methods:
We reviewed The National Readmissions Database (NRD) to identify all TBAD between 2016 and 2020. Patients were stratified by hospital teaching status provided in the NRD. Subgroup analysis of open surgical repair (OSR) versus thoracic endovascular aortic repair (TEVAR) was undertaken. Mixed effects and logistic models were created for 30-day readmission and in-hospital mortality.
Results:
A total of 44,981 patients with a diagnosis of type B aortic dissection were included of which 12 % (5,421) received care at a metropolitan non-teaching (NT) hospital while 88% (39,470) were treated at a metropolitan teaching (T) hospital.
Younger patients (65 years (54-76) vs. 69 years (58-80), p<0.001) with TBAD presented at teaching hospitals and had longer durations of stay (6 days (3-12) vs. 5 days (2-9), p<0.01). The total adjusted charges were expectedly higher at teaching hospitals ($32,300 (12.3-70.2) vs. $16,900 (8.4-44.1), p<0.001). More females were treated at non-teaching hospitals compared to teaching hospitals (43.8% (2376) vs. 39.7% (15,653), p<0.001).
In-hospital mortality was higher at non-teaching hospitals (12.8% (694) vs 11.1% (4391), p<0.001). 30-day readmission rates were comparable between hospital types (NT: 23.2% (996) vs. T: 22% (6977), p=0.07). On both multivariable logistic regression for in-hospital death and multivariable mixed model for readmission, teaching status was not associated with the odds of the respective outcome.
On subgroup analysis, in-hospital death was comparable (NT: 3.8% (11) vs T: 5.5% (210), p=0.22) between hospital types in the TEVAR subgroup as were the 30-day readmission rates (NT: 27.3% (70) vs T: 22.8% (745), p=0.1). However, in the OSR subgroup, in-hospital death rate was lower at teaching hospitals (12.1% (275) vs. 17.8% (32), p=0.027). 30-day readmission rates were comparable in the OSR subgroup.
Conclusion:
Type B aortic dissections continue to be primarily managed by teaching hospitals, with superior in-hospital survival at teaching hospitals. Further, surgical management seems to yield better in-hospital survival at teaching hospitals while no such benefit is seen in TEVAR for TBAD at either type of institution.

Other - Type B aortic dissection