{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T01:47:07Z","timestamp":1789264027350,"version":"build-2803163510"},"reference-count":54,"publisher":"Oxford University Press (OUP)","issue":"41","license":[{"start":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T00:00:00Z","timestamp":1693180800000},"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":[[2023,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>The current study proposes a novel volume\u2013outcome (V\u2013O) meta-analytical approach to determine the optimal annual hospital case volume threshold for cardiovascular interventions in need of centralization. This novel method is applied to surgery for acute type A aortic dissection (ATAAD) as an illustrative example.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search was applied to three electronic databases (1 January 2012 to 29 March 2023). The primary outcome was early mortality in relation to annual hospital case volume. Data were presented by volume quartiles (Qs). Restricted cubic splines were used to demonstrate the V\u2013O relation, and the elbow method was applied to determine the optimal case volume. For clinical interpretation, numbers needed to treat (NNTs) were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>One hundred and forty studies were included, comprising 38 276 patients. A significant non-linear V\u2013O effect was observed (P &amp;lt; .001), with a notable between-quartile difference in early mortality rate [10.3% (Q4) vs. 16.2% (Q1)]. The optimal annual case volume was determined at 38 cases\/year [95% confidence interval (CI) 37\u201340 cases\/year, NNT to save a life in a centre with the optimal volume vs. 10 cases\/year = 21]. More pronounced between-quartile survival differences were observed for long-term survival [10-year survival (Q4) 69% vs. (Q1) 51%, P &amp;lt; .01, adjusted hazard ratio 0.83, 95% CI 0.75\u20130.91 per quartile, NNT to save a life in a high-volume (Q4) vs. low-volume centre (Q1) = 6].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Using this novel approach, the optimal hospital case volume threshold was statistically determined. Centralization of ATAAD care to high-volume centres may lead to improved outcomes. This method can be applied to various other cardiovascular procedures requiring centralization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehad551","type":"journal-article","created":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T00:15:01Z","timestamp":1692231301000},"page":"4357-4372","source":"Crossref","is-referenced-by-count":36,"title":["Type A aortic dissection: optimal annual case volume for surgery"],"prefix":"10.1093","volume":"44","author":[{"given":"Michal J","family":"Kawczynski","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+) , P. Debyelaan 25, 6629HX Maastricht, Limburg , The Netherlands"},{"name":"Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Universiteitssingel 50, Maastricht, PO Box 616, 6200 MD, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sander M J","family":"van Kuijk","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center (MUMC+) , Maastricht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jules R","family":"Olsthoorn","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+) , P. Debyelaan 25, 6629HX Maastricht, Limburg , The Netherlands"},{"name":"Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven , Eindhoven , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos G","family":"Maessen","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+) , P. Debyelaan 25, 6629HX Maastricht, Limburg , The Netherlands"},{"name":"Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Universiteitssingel 50, Maastricht, PO Box 616, 6200 MD, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Kats","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+) , P. 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