{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T22:51:47Z","timestamp":1785451907515,"version":"3.56.0"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,1,25]],"date-time":"2025-01-25T00:00:00Z","timestamp":1737763200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>Previous analyses of the volume\u2013outcome relationship have focused on short-term outcomes such as early mortality. The current study aims to update a novel statistical methodology, facilitating the evaluation of the relation between procedural volume and time-to-event outcomes such as long-term survival, using surgery for acute type A aortic dissection as an illustrative example.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>This study employed an existing dataset of type A dissection outcomes, retrieved from literature. Studies were included when reporting on annual case load and long-term survival, which served as the primary outcome of interest. Individual patient data were reconstructed from the included studies, and a hazard ratio was determined per study in relation to overall survival, after which the calculated hazard ratios were incorporated in a restricted cubic-spline model, facilitating the application of the elbow method.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Fifty-two studies were included (n\u2009=\u200914\u00a0878 patients), with a median follow-up of 5\u2009years. One-, 3-, 5- and 10-year survival of the overall cohort were 82% [95% confidence interval (CI) 82\u201383%], 79% (95% CI 78\u201380%), 74% (95% CI 74\u201375%) and 60% (95% CI 59\u201362%), respectively. A significant non-linear volume\u2013outcome relation for long-term survival was observed in both the unadjusted and adjusted analyses (P\u2009=\u20090.030 and P\u2009=\u20090.002), with an optimal annual case load of 32 cases\/year (95% CI 31\u201333).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Based on the available data, these findings imply that the annual case volume to achieve optimal long-term survival is located near a procedural volume of 32 cases\/year. After accrual of more annual procedures, long-term survival may no longer significantly improve any further.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaf022","type":"journal-article","created":{"date-parts":[[2025,1,25]],"date-time":"2025-01-25T16:32:55Z","timestamp":1737822775000},"source":"Crossref","is-referenced-by-count":7,"title":["The optimal annual case volume for acute type A aortic dissection surgery in relation to long-term outcomes"],"prefix":"10.1093","volume":"67","author":[{"given":"Michal J","family":"Kawczynski","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Maastricht University Medical Centre (MUMC+) , Maastricht,","place":["The Netherlands"]},{"name":"Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2796-729X","authenticated-orcid":false,"given":"Sander M J","family":"van Kuijk","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre (MUMC+) , Maastricht,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jules R","family":"Olsthoorn","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven , Eindhoven,","place":["The Netherlands"]},{"name":"Department of Cardiothoracic Surgery, Isala Hospital Zwolle , Zwolle,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3230-7712","authenticated-orcid":false,"given":"Jos G","family":"Maessen","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Maastricht University Medical Centre (MUMC+) , Maastricht,","place":["The Netherlands"]},{"name":"Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Kats","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Maastricht University Medical Centre (MUMC+) , Maastricht,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9569-4900","authenticated-orcid":false,"given":"Elham","family":"Bidar","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Maastricht University Medical Centre (MUMC+) , Maastricht,","place":["The Netherlands"]},{"name":"Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3531-9997","authenticated-orcid":false,"given":"Samuel","family":"Heuts","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Maastricht University Medical Centre (MUMC+) , Maastricht,","place":["The Netherlands"]},{"name":"Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,1,25]]},"reference":[{"key":"2025030423585810900_ezaf022-B1","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1161\/CIRCULATIONAHA.118.038867","article-title":"Interfacility transfer of Medicare beneficiaries with acute type A aortic dissection and regionalization of care in the United States","volume":"140","author":"Goldstone","year":"2019","journal-title":"Circulation"},{"key":"2025030423585810900_ezaf022-B2","author":"Satopaa","year":"2011"},{"key":"2025030423585810900_ezaf022-B3","doi-asserted-by":"crossref","first-page":"4357","DOI":"10.1093\/eurheartj\/ehad551","article-title":"Type A aortic dissection: optimal annual case volume for surgery","volume":"44","author":"Kawczynski","year":"2023","journal-title":"Eur Heart J"},{"key":"2025030423585810900_ezaf022-B4","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01865-2024","article-title":"The volume-outcome relation for pulmonary endarterectomy in chronic thrombo-embolic pulmonary hypertension","author":"Heuts","year":"2024","journal-title":"Eur Respir J"},{"key":"2025030423585810900_ezaf022-B5","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1016\/j.ejvs.2021.12.045","article-title":"Editor\u2019s choice\u2014Extending aortic replacement beyond the proximal arch in acute type A aortic dissection: a meta-analysis of short term outcomes and long term actuarial survival","volume":"63","author":"Heuts","year":"2022","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2025030423585810900_ezaf022-B6","doi-asserted-by":"crossref","first-page":"4256","DOI":"10.1111\/jocs.16852","article-title":"Long-term outcomes of total arch replacement versus proximal aortic replacement in acute type A aortic dissection: meta-analysis of Kaplan-Meier-derived individual patient data","volume":"37","author":"Sa","year":"2022","journal-title":"J Card Surg"},{"key":"2025030423585810900_ezaf022-B7","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.amjcard.2021.09.049","article-title":"Meta-analysis evaluating high-sensitivity cardiac troponin T kinetics after coronary artery bypass grafting in relation to the current definitions of myocardial infarction","volume":"163","author":"Heuts","year":"2022","journal-title":"Am J Cardiol"},{"key":"2025030423585810900_ezaf022-B8","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1186\/s12874-021-01308-8","article-title":"IPDfromKM: reconstruct individual patient data from published Kaplan-Meier survival curves","volume":"21","author":"Liu","year":"2021","journal-title":"BMC Med Res Methodol"},{"key":"2025030423585810900_ezaf022-B9","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1093\/biostatistics\/kxy071","article-title":"Non-parametric frailty Cox models for hierarchical time-to-event data","volume":"21","author":"Gasperoni","year":"2020","journal-title":"Biostatistics"},{"key":"2025030423585810900_ezaf022-B10","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-19425-7","volume-title":"Regression Modeling Strategies","author":"Harrell","year":"2015"},{"key":"2025030423585810900_ezaf022-B11","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.1016\/j.athoracsur.2013.02.039","article-title":"National outcomes in acute aortic dissection: influence of surgeon and institutional volume on operative mortality","volume":"95","author":"Chikwe","year":"2013","journal-title":"Ann Thorac Surg"},{"key":"2025030423585810900_ezaf022-B12","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1186\/s13019-016-0529-5","article-title":"Outcomes following emergent open repair for thoracic aortic dissection are improved at higher volume centers in direct admissions and transfers","volume":"11","author":"Merlo","year":"2016","journal-title":"J Cardiothorac Surg"},{"key":"2025030423585810900_ezaf022-B13","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1097\/SLA.0000000000002965","article-title":"Toward a consensus on centralization in surgery","volume":"268","author":"Vonlanthen","year":"2018","journal-title":"Ann Surg"},{"key":"2025030423585810900_ezaf022-B14","doi-asserted-by":"crossref","first-page":"e885","DOI":"10.1097\/SLA.0000000000005840","article-title":"Current outcome after surgery for type A aortic dissection","volume":"278","author":"Biancari","year":"2023","journal-title":"Ann Surg"},{"key":"2025030423585810900_ezaf022-B15","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezad426","article-title":"EACTS\/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ","volume":"65","author":"Czerny","year":"2024","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025030423585810900_ezaf022-B16","doi-asserted-by":"crossref","first-page":"6081","DOI":"10.21037\/jtd-24-690","article-title":"Defining the optimal annual institutional case volume for minimally invasive repair of pectus excavatum through a systematic review of literature and meta-analysis of outcomes","volume":"16","author":"Daemen","year":"2024","journal-title":"J Thorac Dis"},{"key":"2025030423585810900_ezaf022-B17","doi-asserted-by":"crossref","first-page":"1796","DOI":"10.1016\/j.jacc.2013.10.085","article-title":"Outcomes of acute type a dissection repair before and after implementation of a multidisciplinary thoracic aortic surgery program","volume":"63","author":"Andersen","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"2025030423585810900_ezaf022-B18","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezae278","article-title":"Transportation model for acute aortic dissection: implications for reduced treatment centres","volume":"66","author":"Goehlich","year":"2024","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025030423585810900_ezaf022-B19","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1136\/heartjnl-2022-320881","article-title":"Imaging surveillance for complications after primary surgery for type A aortic dissection","volume":"109","author":"Heuts","year":"2022","journal-title":"Heart"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejcts\/advance-article-pdf\/doi\/10.1093\/ejcts\/ezaf022\/61625715\/ezaf022.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/67\/2\/ezaf022\/61625715\/ezaf022.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/67\/2\/ezaf022\/61625715\/ezaf022.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T23:59:11Z","timestamp":1741132751000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/doi\/10.1093\/ejcts\/ezaf022\/7979245"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,25]]},"references-count":19,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,2,4]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezaf022","relation":{},"ISSN":["1873-734X"],"issn-type":[{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,2]]},"published":{"date-parts":[[2025,1,25]]},"article-number":"ezaf022"}}