Abstract 17427: Smaller Hospital Bed Size is Associated With Higher Mortality in Stanford Type A Aortic Dissection

Abstract

Introduction: The National Inpatient Sample (NIS) database stratifies hospital bedsize according to the number of hospital beds, urban or rural, and teaching or non-teaching hospital. Larger hospital bed size stratified by these criteria has been associated with better patient care and surgical outcomes in some instances. This study aimed to examine the effect of hospital bed size on perioperative outcomes in Type A Aortic Dissection (TAAD). Methods: Patients who underwent TAAD repair were identified in the NIS from Q4 2015-2020 by ICD10-CM/PCS. NIS stratifies hospital bed size into small, medium, and large, rural vs urban, and teaching status. Patients were stratified into two cohorts: small/medium and large. Significant preoperative differences were present between groups; thus, multivariable logistic regressions were performed to compare the surgical outcomes (in-hospital). Adjusted preoperative variables included sex, age, race, socioeconomic status, comorbidity, primary payer status, hospital characteristics, length of stay (LOS), days from admission to operation, and total hospital charge were compared. Result: There were 1,106 and 3,752 cases with small/medium and large bed sizes, respectively, identified in the NIS database. Among patients admitted to small/medium bed size hospitals, there was higher mortality (17.27% vs 14.37%, aOR=1.32, 95% CI 1.09-1.60, p<0.01), but shorter LOS and lower cost compared to larger hospitals (Table). There was no difference in morbidities (Table). Conclusion: Marked higher mortality is associated with admission to smaller hospital bed sizes among patients with TAAD, which may in turn decrease the average LOS and cost. Given that a significant percentage of patient are already being transferred out of the initial hospital and small/medium hospital size is associated with higher mortality, centralization of care in centers of excellence may decrease the high mortality associated with TAAD.