Learning curve for open surgical repair of acute type A aortic dissection

There is scarce evidence about the surgeon learning curve of acute type A aortic dissection surgery and whether the optimal procedure number exists when training a cardiovascular surgeon. A total of 704 patients with acute type A aortic dissection surgery performed by 17 junior surgeons who can identify their first career surgery from January 1, 2005, to December 31, 2018, are included. The surgeon experience volume is defined as the cumulative number of acute type A aortic dissection surgery of the surgeon since January 1, 2005. The primary outcome was in-hospital mortality. The possibility of non-linearity and cutoffs for surgeon experience volume level was explored using a restricted cubic spline model. The results revealed that more surgeon experience volume is significantly correlated to a lower in-hospital mortality rate (r = - 0.58, P = 0.010). The RCS model shows for an operator who reaches 25 cumulative volumes of acute type A aortic dissection surgery, the average in-hospital mortality rate of the patients can be below 10%. Furthermore, the longer duration from the 1st to 25th operations of the surgeon is significantly correlated to a higher average in-hospital mortality rate of the patients (r = 0.61, p = 0.045). Acute type A aortic dissection surgery has a prominent learning curve in terms of improving clinical outcomes. The findings suggest fostering high-volume surgeons at high-volume hospitals can achieve optimal clinical outcomes.

Automated summary

In this study, the learning curve of cardiovascular surgeons in acute type A aortic dissection surgery and the optimal number of procedures for training were explored. The results showed that surgeon experience volume was significantly correlated with in-hospital mortality rate. For surgeons who reached a cumulative volume of 25 acute type A aortic dissection surgeries, the average in-hospital mortality rate of patients could be below 10%. Additionally, the longer duration from the 1st to 25th operations was significantly correlated with a higher average in-hospital mortality rate. In conclusion, there is a prominent learning curve in acute type A aortic dissection surgery, and fostering high-volume surgeons can achieve optimal clinical outcomes.