The surgeon effect: Volume-outcome relationship in acute type A aortic dissection.

BACKGROUND: Despite advances in technical and perioperative care, surgery for acute type A aortic dissection (ATAAD) carries significant morbidity and mortality. This study evaluated whether high-volume aortic surgeons independently improve perioperative and long-term outcomes compared to their low-volume counterparts. METHODS: Patients who underwent surgery for ATAAD between 2011 and 2024 were identified. A high-volume surgeon was considered one who performed surgery for ATAAD on more than 10 patients annually. Patients were stratified into 2 groups based on the surgeon performing their operation, either a high-volume or low-volume aortic surgeon. RESULTS: A total of 785 patients underwent ATAAD repair, including 715 (91.1%) performed by high-volume surgeons and 70 (8.9%) performed by low-volume surgeons. Preoperative demographics were similar in the 2 groups, although patients operated on by low-volume surgeons had a lower rate of malperfusion (9.9% vs 17.4%; P = .024), had a lower prevalence of peripheral vascular disease (22.5% vs 38.1%; P = .01), and were less likely to have undergone previous cardiac surgery (5.6% vs 14.4%; P = .04). High-volume surgeons performed significantly more aortic root reconstructions (64.1% vs 43.7%; P = .001) and frozen elephant trunk procedures (10.6% vs 4.2%; P = .08). High-volume surgeons were associated with lower 30-day mortality (12.5% vs 22.5%; P = .017), fewer reoperations for bleeding (16.5% vs 26.8%; P = .03), and shorter intensive care unit (ICU) stay (median, 69.3 hours vs 112 hours; P < .001). Kaplan-Meier survival analysis showed that patients operated on by a high-volume surgeon had superior overall survival (P = .04, log-rank test). CONCLUSIONS: High-volume surgeons were associated with superior early outcomes in ATAAD repair, including lower operative mortality, reoperation for bleeding, and ICU utilization, despite performing more complex procedures.