LAUSR

BACKGROUND Thoracic endovascular aortic repair (TEVAR) has significantly improved the ability to treat traumatic aortic injuries (tTEVAR). We sought to determine whether center volume correlated with better outcomes. STUDY DESIGN Vascular Quality Initiative (VQI) TEVAR data (2011-2017) for trauma was used in this analysis. Based on the distribution of annual case volume at participating centers, the sample was stratified into three terciles. In-hospital mortality at high- (HVC) and low-volume (LVC) centers was compared after adjusting for risk factors established in our previous VQI-based risk model containing age, gender, renal impairment, left subclavian artery involvement, and select concomitant injuries. RESULTS A total of 619 tTEVAR cases were studied across 74 centers. HVCs (184 cases) performed ≥4.9 cases/year and LVCs (220 cases) performed ≤2.4 cases/year. Both crude mortality (4.4% vs. 8.6%, P = .22) and adjusted odds of mortality (OR 0.44, 95% CI 0.18 - 1.09, P = .08) trended better for tTEVAR performed at HVC compared to LVC. Addition of center volume to our previous multivariate model significantly improved its discriminative ability (C-statistic 0.90 vs. 0.88, P = .02). Overall TEVAR volume (for all indications) was not associated with increased odds of mortality for tTEVAR (OR 0.46, 95% CI 0.17-1.20, P = .11), nor did it improve the model's discriminative ability. CONCLUSION Higher-volume centers showed improved perioperative mortality after tTEVAR. Thoracic aortic trauma volume was more predictive than overall TEVAR volume, suggesting technical expertise is not the driving factor. Stable patients may benefit from transfer to a higher-volume center prior to repair.