Unwarranted Variation in the Quality of Care for Patients With Diseases of the Thoracic Aorta

Background-thoracic aortic disease has a high mortality. we sought to establish the contribution of unwarranted variation in care to regional differences in outcomes observed in patients with thoracic aortic disease in england. methods and results-data from the hospital episode statistics (hes) and the national adult cardiac surgery audit (nacsa) were extracted. a parallel systematic review/meta-analysis through december 2015,and structure and process questionnaire of english cardiac surgery units were also accomplished. treatment and mortality rates were investigated. a total of 24 548 adult patients in the hes study,8058 in the nacsa study,and 103 543 from a total of 33 studies in the systematic review were obtained. treatment rates for thoracic aortic disease within 6 months of index admission ranged from 7.6% to 31.5% between english counties. risk-adjusted 6-month mortality in untreated patients ranged from 19.4% to 36.3%. regional variation persisted after adjustment for disease or patient factors. regional cardiac units with higher case volumes treated more-complex patients and had significantly lower risk-adjusted mortality relative to low-volume units. the results of the systematic review indicated that the delivery of care by multidisciplinary teams in high-volume units resulted in better outcomes. the observational analyses and the online survey indicated that this is not how services are configured in most units in england. conclusions-changes in the organization of services that address unwarranted variation in the provision of care for patients with thoracic aortic disease in england may result in more-equitable access to treatment and improved outcomes. © 2017 the authors.