The impact of hospital size on national trends and outcomes in isolated open proximal aortic surgery

To determine the impact of hospital size on national trend estimates of isolated open proximal aortic surgery for benchmarking hospital performance. Patients age >18 years who underwent isolated open proximal aortic surgery for aneurysm and dissection from 2002 to 2014 were identified using the National Inpatient Sample. Concomitant valvular, vessel revascularization, re-do procedures, endovascular, and surgery for descending and thoracoabdominal aorta were excluded. Discharges were stratified by hospital size and analyzed using trend, multivariable regression, propensity-score matching analysis. Over a 13-year period, 53,657 isolated open proximal aortic operations were performed nationally. Although the total number of operations/year increased (∼2.9%/year increase) and overall in-hospital mortality decreased (∼4%/year; both P .05). Large hospitals treated more sicker and older patients but had shorter length of stay and lower hospital costs (both P