Feng Jiang, Xiaodi Wang, Michael Carmichael, Yanfei Chen, Ruijian Huang, Yue Xiao, Jifang Zhou, Cunhua Su
{"title":"中美 A 型主动脉夹层的当代手术效果比较：全国住院病人样本数据库和中国多机构登记的分析。","authors":"Feng Jiang, Xiaodi Wang, Michael Carmichael, Yanfei Chen, Ruijian Huang, Yue Xiao, Jifang Zhou, Cunhua Su","doi":"10.1186/s13019-024-03023-z","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>To investigate the contemporary comparative inpatient prognosis among US and Chinese patients with type A aortic dissection (TAAD).</p><p><strong>Methods: </strong>Data from Chinese multi-institutional TAAD registry and the US National Inpatient Sample databases were analyzed. We used multivariable logistic regression models to compare in-hospital mortality and perioperative complication rates between the US and China. Length of stay and overall costs were fitted with quantile regression models. Independent prognostic factors associated with post-operative survival were assessed via Cox proportional hazards models.</p><p><strong>Results: </strong>Among 3,121 eligible TAAD patients, 1,073 were from China (25.0% female; mean ± SD age, 53.9 ± 12.4) and 2,048 were from the US (31.2% female; mean ± SE age, 59.8 ± 0.3). During the study period, the in-hospital mortality rates in China and the US were 15.5% and 13.3%, yet the difference was insignificant after adjustment (aOR, 1.16; 95% CI, 0.69-1.97). While there was no significant difference in overall perioperative complications (aOR, 1.07; 95% CI, 0.52-2.18), the patterns of complications differed between two cohorts. While Chinese TAAD patients experienced significantly longer duration of hospitalization (median difference, + 10.4 days; 95% CI, 9.2-11.5), the US TAAD cohort had significantly greater overall hospitalization costs (49.9; 95% CI, 55.4-44.5, in 1000 USD).</p><p><strong>Conclusions: </strong>Notwithstanding significant differences in demographic and clinical characteristics, TAAD patients from China and the US demonstrated comparable in-hospital mortality and overall perioperative complication rates. Future initiatives should focus on expanding surgical eligibility to the elderly Chinese TAAD patients and optimizing the duration of hospitalization without undermining meaningful clinical outcomes.</p><p><strong>Trial registration: </strong>KY20220425-05, April 5th 25 2022.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"632"},"PeriodicalIF":1.5000,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11566593/pdf/","citationCount":"0","resultStr":"{\"title\":\"Contemporary comparative surgical outcomes of type A aortic dissection in US and China: an analysis of the national inpatient sample database and a Chinese multi-institutional registry.\",\"authors\":\"Feng Jiang, Xiaodi Wang, Michael Carmichael, Yanfei Chen, Ruijian Huang, Yue Xiao, Jifang Zhou, Cunhua Su\",\"doi\":\"10.1186/s13019-024-03023-z\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>To investigate the contemporary comparative inpatient prognosis among US and Chinese patients with type A aortic dissection (TAAD).</p><p><strong>Methods: </strong>Data from Chinese multi-institutional TAAD registry and the US National Inpatient Sample databases were analyzed. We used multivariable logistic regression models to compare in-hospital mortality and perioperative complication rates between the US and China. Length of stay and overall costs were fitted with quantile regression models. Independent prognostic factors associated with post-operative survival were assessed via Cox proportional hazards models.</p><p><strong>Results: </strong>Among 3,121 eligible TAAD patients, 1,073 were from China (25.0% female; mean ± SD age, 53.9 ± 12.4) and 2,048 were from the US (31.2% female; mean ± SE age, 59.8 ± 0.3). During the study period, the in-hospital mortality rates in China and the US were 15.5% and 13.3%, yet the difference was insignificant after adjustment (aOR, 1.16; 95% CI, 0.69-1.97). While there was no significant difference in overall perioperative complications (aOR, 1.07; 95% CI, 0.52-2.18), the patterns of complications differed between two cohorts. While Chinese TAAD patients experienced significantly longer duration of hospitalization (median difference, + 10.4 days; 95% CI, 9.2-11.5), the US TAAD cohort had significantly greater overall hospitalization costs (49.9; 95% CI, 55.4-44.5, in 1000 USD).</p><p><strong>Conclusions: </strong>Notwithstanding significant differences in demographic and clinical characteristics, TAAD patients from China and the US demonstrated comparable in-hospital mortality and overall perioperative complication rates. Future initiatives should focus on expanding surgical eligibility to the elderly Chinese TAAD patients and optimizing the duration of hospitalization without undermining meaningful clinical outcomes.</p><p><strong>Trial registration: </strong>KY20220425-05, April 5th 25 2022.</p>\",\"PeriodicalId\":15201,\"journal\":{\"name\":\"Journal of Cardiothoracic Surgery\",\"volume\":\"19 1\",\"pages\":\"632\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2024-11-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11566593/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Cardiothoracic Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s13019-024-03023-z\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cardiothoracic Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13019-024-03023-z","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Contemporary comparative surgical outcomes of type A aortic dissection in US and China: an analysis of the national inpatient sample database and a Chinese multi-institutional registry.
Background: To investigate the contemporary comparative inpatient prognosis among US and Chinese patients with type A aortic dissection (TAAD).
Methods: Data from Chinese multi-institutional TAAD registry and the US National Inpatient Sample databases were analyzed. We used multivariable logistic regression models to compare in-hospital mortality and perioperative complication rates between the US and China. Length of stay and overall costs were fitted with quantile regression models. Independent prognostic factors associated with post-operative survival were assessed via Cox proportional hazards models.
Results: Among 3,121 eligible TAAD patients, 1,073 were from China (25.0% female; mean ± SD age, 53.9 ± 12.4) and 2,048 were from the US (31.2% female; mean ± SE age, 59.8 ± 0.3). During the study period, the in-hospital mortality rates in China and the US were 15.5% and 13.3%, yet the difference was insignificant after adjustment (aOR, 1.16; 95% CI, 0.69-1.97). While there was no significant difference in overall perioperative complications (aOR, 1.07; 95% CI, 0.52-2.18), the patterns of complications differed between two cohorts. While Chinese TAAD patients experienced significantly longer duration of hospitalization (median difference, + 10.4 days; 95% CI, 9.2-11.5), the US TAAD cohort had significantly greater overall hospitalization costs (49.9; 95% CI, 55.4-44.5, in 1000 USD).
Conclusions: Notwithstanding significant differences in demographic and clinical characteristics, TAAD patients from China and the US demonstrated comparable in-hospital mortality and overall perioperative complication rates. Future initiatives should focus on expanding surgical eligibility to the elderly Chinese TAAD patients and optimizing the duration of hospitalization without undermining meaningful clinical outcomes.
Trial registration: KY20220425-05, April 5th 25 2022.
期刊介绍：
Journal of Cardiothoracic Surgery is an open access journal that encompasses all aspects of research in the field of Cardiology, and Cardiothoracic and Vascular Surgery. The journal publishes original scientific research documenting clinical and experimental advances in cardiac, vascular and thoracic surgery, and related fields.
Topics of interest include surgical techniques, survival rates, surgical complications and their outcomes; along with basic sciences, pediatric conditions, transplantations and clinical trials.
Journal of Cardiothoracic Surgery is of interest to cardiothoracic and vascular surgeons, cardiothoracic anaesthesiologists, cardiologists, chest physicians, and allied health professionals.
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