Surgical repair of type A aortic dissection at safety-net hospitals across the United States.

Abstract

Safety-net hospitals have demonstrated comparable surgical outcomes to non-safety-net hospitals across various populations, highlighting their potential as regional care centers for diagnosis and treatment of time-sensitive conditions. This study evaluated the impact of safety-net status on clinical and financial outcomes following type A aortic dissection repair. The National Inpatient Sample was queried for years 2017 to 2022 to identify adults with a diagnosis of type A aortic dissection. Safety-net hospitals were defined as institutions in the top quartile for the annual proportion of patients with Medicaid or no insurance. Multivariable regression models were used to assess the association of safety-net status with outcomes of interest including in-hospital mortality, perioperative complications, and resource utilization. Of an estimated 25,936 patients with type A aortic dissection undergoing aortic interventions, 7,055 (27.2%) were managed at safety-net hospitals. Compared with non-safety-net hospitals, patients at safety-net hospitals had a similar distribution of age, sex, and Elixhauser Comorbidity Index. After excluding patients who did not receive aortic surgical interventions, the proportion of cases transferred into safety-net hospitals increased from 27.5% to 48.1%. Following adequate risk adjustment, safety-net hospitals did not alter the odds of in-hospital mortality (adjusted odds ratio 1.15, 95% confidence interval 0.72-1.83, reference: non-safety-net hospitals). Notably, higher type A aortic dissection center volume was linked with reduced odds of death, independent of safety-net status (adjusted odds ratio 0.94, 95% confidence interval 0.91-0.97). Our findings suggest that safety-net hospitals yield comparable perioperative outcomes to non-safety-net hospitals in management of type A aortic dissection outcomes. Future studies are warranted to further investigate the impact of safety-net status on long-term outcomes, as well as rates of readmission and reoperation.