Quality assessment in open surgical repair of thoracic aortic disease

Abstract

Risk-prediction and quality-assurance models facilitate comparison of surgeons, institutions, and emerging alternative technologies. With comparative context, the most meaningful outcomes for thoracic aortic (TA) repair can be identified, evaluated, and adopted to improve open TA repair among a variety of providers; moreover, open TA repair can be more accurately compared to endovascular TA repair. Although the EuroSCORE risk-stratification model was not specifically designed for TA repair, it is largely suitable for this purpose despite the aged dataset from which it was developed. However, such prediction models could be improved by expanding their end points to include not only mortality but other life-altering adverse events, such as paraplegia, stroke, and renal failure. Population-based studies may be useful in establishing trends and should be conducted in a fashion that will enhance their external applicability; procedure-volume studies are often limited as comparative benchmarks. Additionally, experienced centers have great value because they can report the outcomes of large numbers of cases. Despite a tendency to take on challenging cases, centers of excellence consistently report better outcomes than those observed in population studies. Stratifying reported outcomes for risk level and urgency of repair may have value, because it would avoid penalizing surgeons for taking on complex repairs. For the average patient with few comorbidities, the most durable and established repair should be offered, and the best contemporary success rates should be presented to facilitate that choice.