The Impact of Hospital Size on National Trends and Outcomes in Isolated Open Proximal Aortic Surgery

ABSTRACT Objective To determine the impact of hospital size on national trend estimates of isolated open proximal aortic surgery for benchmarking hospital performance. Methods Patients age >18 years who underwent isolated open proximal aortic surgery for aneurysm and dissection from 2002 to 2014 were identified using the National Inpatient Sample. Concomitant valvular, vessel revascularization, re-do procedures, endovascular and surgery for descending and thoracoabdominal aorta were excluded. Discharges were stratified by hospital size, and analyzed using trend, multivariable regression, propensity-score matching analysis. Results Over a 13-year period, 53,657 isolated open proximal aortic operations were performed nationally. While the total number of operations/year increased (∼2.9%/year increase), and overall in-hospital mortality decreased (∼4%/year; both P 0.05). Large hospitals treated more sicker and older patients, but had shorter length of stay and lower hospital costs (both P Conclusions This study demonstrates increasing volume and improving outcomes of isolated open proximal aortic surgeries nationally over the last decade regardless of hospital bed size. Moreover, the resource allocation of sicker patients to larger hospital resulted shorter LOS and hospital costs, whilst maintaining similar operative mortality to small and medium size hospitals.