Contemporary Comparative Surgical Outcomes of Type A Aortic Dissection in US and China: an Analysis of the National Inpatient Sample Database and a Chinese Multi-Institutional Registry

Contemporary Comparative Surgical Outcomes of Type A Aortic Dissection in US and China: an Analysis of the National Inpatient Sample Database and a Chinese Multi-Institutional Registry | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Contemporary Comparative Surgical Outcomes of Type A Aortic Dissection in US and China: an Analysis of the National Inpatient Sample Database and a Chinese Multi-Institutional Registry Feng Jiang, Cunhua Su, Michael Carmichael, Yanfei Chen, Ruijian Huang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4019578/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Nov, 2024 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted 11 You are reading this latest preprint version Abstract Background: To investigate the contemporary comparative inpatient prognosis among US and Chinese patients with type A aortic dissection (TAAD). Methods: Data from Chinese multi-institutional TAAD registry and the US National Inpatient Sample databases were analyzed. We used multivariable logistic regression models to compare in-hospital mortality and perioperative complication rates between the US and China. Length of stay and overall costs were fitted with quantile regression models. Independent prognostic factors associated with post-operative survival were assessed via Cox proportional hazards models. Results: Among 3,121 eligible TAAD patients, 1,073 were from China (25.0% female; mean ± SD age, 53.9±12.4) and 2,048 were from the US (31.2% female; mean ± SE age, 59.8 ± 0.3). During the study period, the in-hospital mortality rates in China and the US were 15.5% and 13.3%, yet the difference was insignificant after adjustment (aOR, 1.16; 95% CI, 0.69-1.97). While there was no significant difference in overall perioperative complications (aOR, 1.07; 95% CI, 0.52-2.18), the patterns of complications differed between two cohorts. While Chinese TAAD patients experienced significantly longer duration of hospitalization (median difference, +10.4 days; 95% CI, 9.2-11.5), the US TAAD cohort had significantly greater overall hospitalization costs (49.9; 95% CI, 55.4-44.5, in 1000 USD). Conclusions: Notwithstanding significant differences in demographic and clinical characteristics, TAAD patients from China and the US demonstrated comparable in-hospital mortality and overall perioperative complication rates. Future initiatives should focus on expanding surgical eligibility to the elderly Chinese TAAD patients and optimizing the duration of hospitalization without undermining meaningful clinical outcomes. Trial registration : KY20220425-05, April 5th 25 2022 Cohort study In-hospital mortality Perioperative complication Type A aortic dissection Surgery Figures Figure 1 Figure 2 Figure 3 Introduction The burden posed by aortic dissection, specifically type A aortic dissection (TAAD), has been noteworthy due to its sudden onset, requiring immediate surgical interventions, and leading to substantial mortality rates. However, the mortality rate has been observed to vary significantly across different countries. 1-4 Indications for TAAD surgery as well as associate prognosis could vary across industrialized countries. In Japan, the incidence of operative mortality was found to be between 9%-11%, 5, 6 while in the International Registry of Acute Aortic Dissection (IRAD), the rate was recorded to be as high as 18%-25%. 7 In the United States, the mortality rate ranged from 15%-20%, 8, 9 while in Germany, it was 16.9% 10 and in the United Kingdom, the rate was between 15%-23%. 11, 12 The differences in patient demographic and clinical characteristics, as well as the discrepancies in the provision of high-quality surgical services between countries, may have contributed to the unequal clinical outcomes between industrialized and middle-income countries such as China. Mortality rates for relevant studies in China in the same period ranged from 5%-11%, and a higher proportion of younger patients with TAAD might partly explain the lower mortality rates. 13-15 Furthermore, the mortality rate has gradually decreased over the past decade due to better postoperative care and continuously improving surgical operations. 4, 7-12 Nevertheless, current data on comparative outcomes remained limited, especially during the period of disruption to life-saving surgical services worldwide caused by the COVID-19 pandemic. 16 The prevention and mitigation of perioperative complications were vital initiatives that aim to enhance the outcomes of type A open surgical repair (TASR). However, the available literature demonstrated a dearth of studies focusing on comparing the incidence rates and trends of perioperative complications across different nations. 6-12 Regrettably, current studies predominantly discussed the state of TAAD in specific geographic areas or nations, with the exception of the International Registry of Acute Aortic Dissection, which has not evaluated the specific conditions of TAAD patients in diverse countries. 7, 17 Therefore, the aim of this study was to compare the contemporary trends in in-hospital mortality and perioperative complications between US and Chinese patients with TAAD. To understand the shifting patterns of surgical management over time and to estimate the length of stay (LOS) and costs in real-world setting. Methods Data Source Data sources included the US National Inpatient Sample (NIS) databases (2015-2019) and inpatient data from multiple centers in China (2012-2021). At first, the Hospital Cost and Utilization Project’s consists of a series of databases and associated software tools, created by a federal-state-industry collaboration and funded by the Agency for Health Research and Quality. Within Hospital Cost and Utilization Project, the NIS serves as the largest publicly accessible claims database, capturing 20% of inpatient data across the United States. On the other hand, Chinese multicenter data on TAAD were collected from 11 medical institutions in Jiangsu Province. A range of patient characteristics, including demographics, in-hospital mortality and related complications, and the type of operation performed were systematically recorded. Human ethics and consent to participate declarations The experimental protocol was established, according to the ethical guidelines of the Helsinki Declaration and was approved by the Human Ethics Committee of the institutional review board of the China Pharmaceutical University. Since the data were deidentified, the requirement for informed consent was therefore waived. Patient population The final analytical dataset consisted of 3,121 patients with TAAD who received surgical interventions during their index admission in the US and China during the study period. In the US cohort, we used a validated algorithm to determine types of aortic dissection. 3, 8 Patients received surgical management were categorized into three groups: type A open surgical repair (TASR), type B open surgical repair (TBSR) and thoracic endovascular aortic repair (TEVAR). We initially used ICD-9 to find procedure codes for dissection repair: resection of aorta, abdominal or thoracic vessels with replacement, resection of aorta or other thoracic vessels with anastomosis, or repair of blood vessel with synthetic patch graft or unspecified type of patch graft; procedure codes for cardiac surgery: cardioplegia, valve repair, or operations on vessels of the heart; and repeated the previous action using ICD-10. Patients with procedure codes for dissection repair and cardiac surgery were categorized as a TASR. Eligible patients were at least 18 years old at admission and had at least one ICD-9-CM or ICD-10-CM code indicative of aortic dissection. We subsequently excluded individuals from the study cohort who possessed unknown vital status at the time of discharge, exhibited indications of an aortic aneurysm, or underwent transfer on the day of admission. Relevant International Classification of Diseases codes were referred to in Supplemental Table 1 . In the Chinese TAAD cohort, patients with only endovascular or medical management or younger than 18 were excluded. We extracted relevant clinical variables from the patient registries of the hospitals, including patient demographics, clinical symptoms and signs, imaging findings, outcomes, and cause of death. We also continuously tracked the survival status and prognosis of some patients through telephone interviews. Outcomes measures Our primary outcomes included in-hospital mortality and rates of complications. We also evaluated the length of hospitalization and healthcare costs for patients with TAAD in the United States and China. Further, we analyzed the surgical management patterns in the Chinese TAAD cohort and factors associated with long-term survival. To directly compare the outcomes of Chinese and US patients, we used the demographic distributions extracted from the 2010 US census data to standardize the mortality and other indicators of the Chinese and US cohorts. Baseline characteristics were expressed as frequencies and percentages for categorical variables and medians (interquartile range, IQR) for continuous variables. Differences in baseline characteristics were compared by χ2 or rank sum test, as appropriate. Kaplan-Meier analysis was used to assess overall survival, and a multivariate Cox proportional hazards model was utilized to identify factors associated with overall mortality. All statistical tests were two-sided, with a P<0.05 indicating statistical significance. Data were analyzed using R version 3.5.1 and SAS 9.4. Result The final cohorts included 3,121 inpatient admissions, with 2,048 from the United States and 1,073 from China ( Figure 1 ). In the Chinese multi-institution registry, patients were monitored post-discharge until death, loss to follow-up, or until the end of the study period (Dec 31st, 2021). the median (IQR) follow-up duration was 2.00 (1.58-2.75) years ( Supplemental Figure 1 ). Baseline characteristics The baseline characteristics of the Chinese and US patients who underwent TAAD surgery throughout the study period were demonstrated in Table 1 . The Chinese cohort was found to be younger, and had a lower proportion of women and higher weekend admissions than the US cohort (21.0% vs. 31.2%, P<0.05; 28.5% vs. 23.1%, P<0.05). Two cohorts also differed significantly in terms of racial status and insurance types. Notably, several comorbidities in the US cohort were more common than those in the Chinese cohort, such as type 2 diabetes, dyslipidemia, coronary artery disease and heart failure. On the other hand, a higher proportion of Chinese patients suffered from hypertension, chronic liver disease, stroke, and Marfan syndrome compared to the US counterparts. Overall, the prevalence rate of comorbidities was higher in the US cohort. Table 1. Baseline descriptive demographic and clinical characteristics of the cohorts US NIS cohort (N= 2048 ) Chinese cohort (N=1 073 ） P value Age at admission , ( yrs, % ) Mean (±SE/SD) 59.8±0.3 53.9±12.4 Median (IQR) 60.3 (49.8-70.0) 54 (46-63) Age group (%) <.0001 ≤49 23.7 36.1 50-59 23.5 30.4 60-69 25.8 22.6 70-79 20.5 10.0 80+ 6.5 0.9 Female sex (%) 31.2 25.0 0.0003 Year of admission (%) 2012-2015 22.5 22.6 2016 18.4 6.7 2017 19.6 8.4 2018 18.3 10.1 2019-2021 21.2 52.2 Race/ethnicity (%) <.0001 Non-Hispanic white 66.6 0 African American 18.3 0 Hispanic 7.3 0 Asian, Pacific Islander 4.0 100 Native American 0.2 0 Other/unknown 3.6 0 Quartile of median income (%) Quartile 1 (less wealthy) 26.0 NA Quartile 2 23.5 NA Quartile 3 24.9 NA Quartile 4 (wealthier) 25.8 NA Insurance type (%) <.0001 Public insurance 54.0 54.3 Private Insurance 36.0 0 Self-pay/Others 10.0 45.7 Weekend admission (%) 23.1 28.5 0.0009 Chronic conditions (%) Type 2 diabetes 10.9 7.2 0.0012 Hypertension 66.4 77.9 <.0001 Dyslipidemia 31.1 5.5 <.0001 Chronic kidney disease 5.8 5.7 0.91 Coronary artery disease 19.8 6.4 <.0001 Heart failure 20.4 14.1 <.0001 Chronic liver disease 1.2 5.7 <.0001 Stroke 4.9 6.7 <.0001 Chronic obstructive pulmonary disease 16.6 3.7 <.0001 Atrial fibrillation 23.8 4.2 <.0001 Obesity* 18.3 8.7 <.0001 Marfan syndrome 1.5 4.9 <.0001 Char l son comorbidity index (%) <.0001 0-2 14.7 57.7 3-4 31.2 32.4 5+ 54.1 9.9 Footnotes: * Obesity status was determined using the estimated body mass index (BMI) at admission, with BMI equal or above 30 considered as obese. Abbreviations: NIS, national inpatient sample; SE standard error; SD, standard deviation; IQR, inter quartile range Mortality and perioperative complications During the study period, in-hospital mortality for two cohorts decreased modestly, and the Chinese cohort seemed to have a better performance in this regard ( Table 2 and Table 3 ; OR, 0.84; 95% CI, 0.70-0.997). After accounting for greater mortality risks among the elderly patients, the standardized in-hospital mortality rates were comparable. Furthermore, mortality was not significantly different in the fully adjusted model (OR, 1.16; 95% CI, 0.69-1.97). Renal complications were more prevalent in Chinese patients, and this finding was constant regardless of models ( Figure 2 and Table 3 ; OR, 2.00; 95% CI, 1.25-3.19). Permanent neurological deficits were less common in the Chinese cohort than temporary neurological dysfunction, but the converse was true in the US cohort (OR, 0.51; 95% CI, 0.34-0.77; OR, 1.41; 95% CI, 1.01-1.98). The incidences of cardiac and respiratory complications were most prevalent, accounting for about half of all cases, and there was no significant difference between the US and Chinese cohorts (OR, 1.19; 95% CI, 0.77-1.85; OR, 0.61; 95% CI, 0.36-1.04). Similarly, there was no significant difference in overall complications (OR, 1.07; 95% CI, 0.52-2.18). Additionally, the trend of complication rates in the Chinese cohort showed greater volatility, while that in the US cohort was relatively stable ( Supplemental Figure 2 ). Table 2. Observed crude and adjusted rates of in-hospital patient outcomes and associated costs in two cohorts Outcomes Overall 2012-2015 2016 2017 2018 2019-202 1 Crude estimates (US) (N= 2048 ) (N= 460 ) (N= 376 ) (N= 402 ) (N= 375 ) (N= 435 ) in-hospital mortality 15.5 17.4 17.6 12.9 15.2 14.5 in-hospital mortality(age:80+) 24.1 27.6 19.2 30.0 21.1 20.1 LOS, in days (median, IQR) 9.4 (6.0-15.7) 9.0 (5.8-14.4) 9.3 (6.2-15.4) 9.7 (6.0-15.4) 9.1 (5.6-16.6) 10.3 (6.2-17.2) Prolonged stay* 7.5 5.4 8.8 5.5 7.5 10.6 Waiting time, in days (%) 0 73.3 70.2 73.9 72.6 73.9 76.1 1 16.9 18.0 15.7 17.9 16.0 16.3 2+ 7.6 11.7 10.4 9.5 10.1 7.6 Costs, in1,000 US dollar (median, IQR) 74.5 (51.0-112.7) 68.3 (50.0-99.8) 70.0 (50.9-109.1) 74.2 (51.6-110.5) 75.4 (49.6-109.8) 83.7 (54.1-134.3) Complications Respiratory complications a 43.5 48.9 40.4 42.0 46.1 39.3 Cardiac complications b 53.7 59.8 52.1 52.5 53.9 49.7 Renal complications c 9.3 8.5 10.1 8.0 10.4 9.9 Permanent neurological deficits d 11.3 18.0 6.1 9.0 9.9 12.0 Temporary neurological dysfunction e 7.6 5.7 5.3 8.7 8.0 10.1 Infectious complications f 25.2 25.0 25.3 25.4 24.3 26.2 Overall complications 77.3 80.7 76.1 76.1 78.1 75.2 Crude estimates (China) (N= 1073 ) (N= 243 ) (N= 72 ) (N= 90 ) (N= 108 ) (N= 560) in-hospital mortality 13.3 14.8 11.1 12.2 16.7 12.5 LOS, in days (median, IQR) 20 (16-26) 21 (17-26) 21.5 (19-25.5) 21.5 (18-28) 20 (15-24) 20 (15-27) Prolonged stay* 17.2 18.9 13.9 18.9 9.3 18.0 Waiting time, in days (%) 0 57.9 38.7 52.8 60.0 67.6 64.8 1 24.7 30.5 27.8 28.9 22.2 21.6 2+ 17.4 30.9 19.4 11.1 10.2 13.6 Costs, in 1,000 US dollar (median, IQR) 31.1 (27.4-36.9) 29.6 (26.4-33.4) 30.1 (27.7-36.9) 33.4 (29.8-40.2) 32.6 (28.5-36.7) 31.2 (27.4-39.2) Complications Respiratory complications a 47.8 51.0 55.6 60.0 44.9 44.0 Cardiac complications b 41.5 22.6 37.5 42.2 36.5 51.3 Renal complications c 17.0 14.0 25.0 28.9 23.4 14.2 Permanent neurological deficits d 6.1 7.4 5.6 6.7 9.4 4.5 Temporary neurological dysfunction e 10.3 16.5 11.1 13.3 9.4 6.4 Infectious complications f 28.1 32.5 29.2 13.3 23.4 27.8 Overall complications 68.7 65.4 76.4 71.1 63.9 69.8 Age- and sex- standardized estimates (US) in-hospital mortality 9.0 11.9 9.8 7.1 6.1 9.3 LOS, in days (median, IQR) 10 (6-16) 6 (9-15) 10 (7-16) 10 (6-16) 10 (6-17) 11 (7-18) Prolonged stay* 4.2 3.2 5.8 3.0 4.8 4.8 Costs, in 1,000 US dollar (median, IQR) 74.6 (51.0-112.7) 68.7 (49.6-100.5) 70.1 (50.9-109.2) 74.4 (51.7-110.6) 75.5 (49.6-110.2) 83.7 (54.1-136.3) Complications Respiratory complications a 25.8 30.4 25.8 22.6 31.2 22.0 Cardiac complications b 32.0 32.7 28.1 29.4 30.6 35.6 Renal complications c 5.9 6.7 6.7 4.0 6.7 5.4 Permanent neurological deficits d 6.5 10.9 3.1 4.0 7.1 8.3 Temporary neurological dysfunction e 4.1 3.3 2.5 5.1 4.0 4.6 Infectious complications f 14.5 14.7 13.6 15.0 14.9 15.8 Overall complications 48.1 49.1 45.6 44.8 49.4 50.7 Age- and sex- standardized estimates (China) in-hospital mortality 11.0 11.6 5.9 5.7 10.3 9.3 LOS, in days 20 (16-26) 21 (17-26) 21.5 (19-25.5) 21.5 (18-28) 20 (15-24) 20 (15-27) Prolonged stay* 16.3 13.7 5.8 9.9 5.9 19.4 Costs, in 1,000 US dollar 31.1 (27.4-36.9) 29.6 (26.4-33.4) 30.1 (27.7-36.9) 33.4 (29.8-40.2) 32.6 (28.5-36.7) 31.7 (27.4-39.2) Complications Respiratory complications a 31.1 36.5 31.1 30.6 22.1 28.0 Cardiac complications b 30.0 18.9 26.1 19.2 20.8 32.8 Renal complications c 16.0 9.6 3.8 14.7 12.2 6.1 Permanent neurological deficits d 3.8 6.1 3.0 1.7 3.3 3.5 Temporary neurological dysfunction e 4.9 8.9 4.0 5.5 3.7 2.1 Infectious complications f 20.2 26.1 16.7 13.0 13.7 17.5 Overall complications 50.0 53.2 45.1 37.6 33.5 45.8 Footnotes: *Prolonged stay was defined as admissions with length of stay equal or above 30 days. a Respiratory complications included hypoxia, pneumonia, prolonged ventilation (>12h), postoperative reintubation, acute respiratory distress syndrome and respiratory failure. b Cardiac complications included low cardiac output syndrome, cardiac arrest, postoperative arrhythmia, heart conduction disturbance, perioperative myocardial infarction, mitral insufficiency, aortic insufficiency, tricuspid insufficiency, perivalvular leakage, pericardial effusion and cardiac tamponade. c Renal complications included acute kidney injury and renal failure requiring renal replacement therapy. d Permanent neurological deficits included stroke, paraplegia, spinal cord complications and sensory disorders. e Temporary neurologic dysfunction included transient ischemic attack and delirium. f Infectious complications included bacteremia, sepsis, wound infection, infections of mediastinum, pulmonary infection/pneumonia, urinary tract infection, endocarditis, pericarditis; skin/soft tissue infection and infection of unknown site. Abbreviations: IQR, inter quartile range; LOS, length of stay. Table 3. Comparative outcomes between two cohorts on in-hospital mortality, prolonged length of stay and perioperative complications Outcomes China (Comparator, %) US (Reference, %) Absolute differences (95% CI) OR (95% CI) Crude Model In-hospital mortality 13.3% 15.5% -0.02 (-0.05, 0.004) 0.84 (0.70, 0.997) Prolonged stay* 17.2% 7.5% 0.10 (0.07, 0.12) 2.55 (1.88, 3.45) Any perioperative complications 68.7% 77.3% -0.09 (-0.12, -0.05) 0.65 (0.42, 1.01) Specific complications Respiratory complications a 47.8% 43.5% 0.04 (0.002, 0.08) 1.19 (0.77, 1.85) Cardiac complications b 41.5% 53.7% -0.13 (-0.16, -0.09) 0.61 (0.36, 1.04) Renal complications c 17.0% 9.3% 0.08 (0.05, 0.10) 2.00 (1.25, 3.19) Permanent neurological deficits d 6.1% 11.3% -0.06 (-0.08, -0.04) 0.51 (0.34, 0.77) Temporary neurological dysfunction e 10.3% 7.6% 0.02 (-0.01, 0.04) 1.41 (1.01, 1.98) Infectious complications f 28.1% 25.2% 0.03 (0.01, 0.06) 1.16 (0.93, 1.45) Adjusted Model 1 ** In-hospital mortality 11.0% 9.0% 1.00 (0.81, 1.23) Prolonged stay* 4.2% 16.3% 2.61 (1.93, 3.53) Any perioperative complications 48.1% 50.0% 0.76 (0.48, 1.22) Adjusted Model 2 ** In-hospital mortality 11.0% 9.0% 1.06 (0.74, 1.53) Prolonged stay* 4.2% 16.3% 1.78 (1.20, 2.65) Any perioperative complications 48.1% 50.0% 0.75 (0.45, 1.27) Adjusted Model 3 ** in-hospital mortality 11.0% 9.0% 1.10 (0.74, 1.63) Prolonged stay* 4.2% 16.3% 2.18 (1.38, 3.44) Any perioperative complications 48.1% 50.0% 1.10 (0.56, 2.14) Adjusted Model 4 ** in-hospital mortality 11.0% 9.0% 1.16 (0.69, 1.98) Prolonged stay* 4.2% 16.3% 2.42 (1.29, 4.56) Any perioperative complications 48.1% 50.0% 1.07 (0.52, 2.18) Footnotes: *Prolonged stay was defined as admissions with length of stay equal or above 30 days. **Model 1 was adjusted for sex and age at admission; Model 2 was adjusted for sex, age, and race/ethnicity status; Model 3 was adjusted for all demographic and clinical characteristics; Model 4 was adjusted for all demographic and clinical characteristics and characteristics of healthcare facilities. a Respiratory complications included hypoxia, pneumonia, prolonged ventilation (>12h), postoperative reintubation, acute respiratory distress syndrome and respiratory failure. b Cardiac complications included low cardiac output syndrome, cardiac arrest, postoperative arrhythmia, heart conduction disturbance, perioperative myocardial infarction, mitral insufficiency, aortic insufficiency, tricuspid insufficiency, perivalvular leakage, pericardial effusion and cardiac tamponade. c Renal complications included acute kidney injury and renal failure requiring renal replacement therapy. d Permanent neurological deficits included stroke, paraplegia, spinal cord complications and sensory disorders. e Temporary neurologic dysfunction included transient ischemic attack and delirium. f Infectious complications included bacteremia, sepsis, wound infection, infections of mediastinum, pulmonary infection/pneumonia, urinary tract infection, endocarditis, pericarditis; skin/soft tissue infection and infection of unknown site. Abbreviations: OR, odds ratio. Length of stay and health care cost After comparing length of stay and costs between the Chinese and US cohorts, it was found that the Chinese cohort maintained a longer length of stay and lower total costs, even after accounting for standardized length of stay and costs ( Table 2 ). After adjusting for relevant covariates, the Chinese cohort still had lower overall in-hospital costs ( Table 4 ; median net increase, -49.9; 95% CI, -55.4--44.5). We further analyzed the Chinese cohort and found that patients who underwent total arch replacement surgery spent significantly more during their hospitalization than those who underwent ascending or hemi-arch replacement surgery ( Supplemental Table 5 ). Meanwhile, the length of stay in the Chinese cohort was significantly longer than that in the US cohort (median net increase, 10.4; 95% CI, 9.2-11.5). Furthermore, we found the same tendency in prolonged stay (OR, 2.42; 95% CI, 1.29-4.56). On the other hand, related medical expenses in the United States continued to grow, while those in China remained stable during the study period. Additionally, the US cohort tended to have a shorter waiting time from admission to surgical procedures. Table 4 . Comparative outcomes between two cohorts on length of stay and overall costs Outcomes China (Comparator) US (Reference) Median Net Increase in LOS/Cost (Days/$) (95% CI) Quantile regression model Crude Model LOS (median, IQR) 20 (16-26) 9.4 (6.0-15.7) 10.0 (10.0-32.3) Costs, in 1,000 US dollar (median, IQR) 31.1 (27.4-36.9) 74.5 (51.0-112.7) -43.4 (-44.3, -42.3) Adjusted Model 1** LOS (median, IQR) 20 (16-26) 9.4 (6.0-15.7) 7.1 (5.2-9.4) Costs, in 1,000 US dollar (median, IQR) 31.1 (27.4-36.9) 74.5 (51.0-112.7) -42.4 (-43.3, -41.5) Adjusted Model 2** LOS (median, IQR) 20 (16-26) 9.4 (6.0-15.7) 10.2 (9.3-11.6) Costs, in 1,000 US dollar (median, IQR) 31.1 (27.4-36.9) 74.5 (51.0-112.7) -51.9 (-54.3, -50.2) Adjusted Model 3** LOS (median, IQR) 20 (16-26) 9.4 (6.0-15.7) 10.8 (9.7-11.6) Costs, in 1,000 US dollar (median, IQR) 31.1 (27.4-36.9) 74.5 (51.0-112.7) -45.3 (-48.0, -40.2) Adjusted Model 4** LOS (median, IQR) 20 (16-26) 9.4 (6.0-15.7) 10.4 (9.2-11.5) Costs, in 1,000 US dollar (median, IQR) 31.1 (27.4-36.9) 74.5 (51.0-112.7) -49.9 (-55.4, -44.5) Footnotes: *Prolonged stay was defined as admissions with length of stay equal or above 30 days. **Model 1 was adjusted for sex and age at admission; Model 2 was adjusted for sex, age, and race/ethnicity status; Model 3 was adjusted for all demographic characteristics; Model 4 was adjusted for all demographic and clinical characteristics and characteristics of healthcare facilities. Abbreviations: IQR, inter quartile range; LOS, length of stay Long-term survival The preliminary results showed that age, burden of comorbidity (measured by Charlson comorbidity index), type 2 diabetes, chronic kidney disease, coronary heart disease, heart failure, stroke, liver disease and surgical complexity were all significantly related to the long-term survival of TAAD patients after surgery ( Figure 3, Supplemental Figure 3 and Supplemental Table 3 ). For example, compared with patients under 50 years old, the long-term mortality rate of patients over 70 years old increased by 187% (HR, 2.87; 95% CI, 1.92-4.29). After adjusting the relevant variables, and the type and complexity of surgery still had a significant impact on the long-term survival rate. Among them, the choice of total arch replacement surgery or compound surgery was associated with lower long-term survival rate. We further investigated operative management in the Chinese cohort ( Supplemental Table 4 ). Among analyzed TAAD patients, 80.7% underwent total arch replacement surgery, while 32.8% subjects underwent two or more types of surgical procedures. Discussion In this study, we compared the characteristics and outcomes of patients undergoing surgery for TAAD by using the US NIS database and the Chinese multicenter registry. The Chinese cohort represented the largest contemporary Chinese TAAD cohort to undergo surgical management, 13, 15, 18 and we collected follow-up data to analyze prognostic factors associated with long-term survival. As previously reported, Chinese patients were relatively younger and appeared to have lower comorbid burdens. 13-15, 18 The in-hospital mortality rates observed in US and Chinese patients were consistent with recent literature. 8-10, 12, 19 Nevertheless, other cohorts showed higher or lower mortality rates owing to differences in study period, country and demographic characteristics. 6, 7, 11, 13-15, 18 The waiting time from admission to surgery was significantly longer among the Chinese cohort compared to the US. Meanwhile, despite the longer length of stay in China, overall costs were lower compared to US hospitalizations for TAAD. Mortality rates in the US and Chinese cohorts remained stable during the study period, while differences between the two countries persisted. There were five possible explanations for the difference in mortality rates before standardized. Firstly, the age distribution of the patients differed across the two nations. Specifically, elderly patients over the age of 80 accounted for only 0.9% of the Chinese cohort while composing 6.5% of the US cohort. Given the heightened mortality risk for individuals in this age group, 9, 19, 20 questions remained unresolved regarding whether surgical intervention would benefit elderly patients with acute TAAD. 21-24 In China, considering that the reported in-hospital mortality and postoperative complications were both very high for patients aged above 80 years old at diagnosis, octogenarians with acute TAAD were more likely to defer surgery due to perceived worsened survival relative to medical management. 22, 24 Secondly, most of the patients in the Chinese cohort were transferred to hospitals with greater accreditation for treatment, and prior studies have proven the mortality rate of TAAD patients was directly proportional to the hospital surgery volume. 25 Thirdly, many patients with acute TAAD might die before admission or diagnosis in China, owing to insufficient emergency rescue forces. 14 Fourth, although no data was available from the NIS, according to a relatively new study from the University of Michigan, hemiarch replacement was 57.8% compared to aggressive arch replacement. 26 Conversely, most Chinese surgeons thought that total arch replacement combined with stented elephant trunk implantation was a “standard” therapy for TAAD involving the repair of the aortic arch, which was 70.8% (80% in this study) compared to conventional surgical repair. 13 The present study found comparable rates of complications between the United States and China, yet the US cohort demonstrated a more consistent long-term trend in the occurrence of various complications. This finding might reflect the greater maturity of treatment strategies and overall healthcare delivery in the United States. On the contrary, the incidence rates of complications fluctuated greatly in Chinese patients, notably the rate of cardiac complications, which might be ascribed to an increase in the complexity of operations performed and the number of patients undergoing surgery for TAAD related to the establishment of Chest Pain Center. With increasing numbers of Chest pain Centers established across Jiangsu Province, the accessibility of emergency surgical services for local patients with complex TAAD has been drastically improved. Our study corroborated that the US centers had higher turn-over rates as demonstrated by significantly shorter length of stay. Nevertheless, US centers charged for much higher medical expenses. The reasons for the difference in length of stay were complex and multifactorial. One reason was that the length of stay of patients was strictly limited by insurance companies in the US, while the cost was paid by basic medical insurance or out-of-pocket in China. Another reason was that discharged patients had the option of being transferred to post-acute care settings in the US, such as skilled nursing facility, rehabilitation or nursing home, 27 which was quite different from the vast majority of Chinese patients returning home after discharge. While the most likely reason for the difference in overall costs could have been inexpensive surgical treatment and lower administrative expenditures in Chinese public health system. The results of multivariate analysis indicated that the severity of associated complications and the choice of TAAD surgical methods were related to the long-term survival of patients, and the impact of age on that was not significant after variable adjustment. Bojko et al. reported that heart failure, postoperative renal failure and stroke were significant independent predictors of all-cause mortality, paralleling the results of the current study. 28 We also found total arch replacement or single surgery tended to be associated with reduced long-term survival. Nevertheless, the effects of different aortic dissection operations were controversial internationally. 29 The sample size of patients with ascending aortic replacement or hemiarch replacement patients may have limited the statistical power to detect disparities. Furthermore, the choice of surgical strategy depended on the patient's condition and was not randomized. Therefore, further research was needed to prove the superiority of total arch replacement or hemiarch replacement. Additionally, our study revealed that advanced age did not exhibit a statistically significant correlation with long-term survival, which was consistent with previous studies on the surgical repair of acute TAAD in elderly patients. 30 This study provided valuable insights into potential avenues for enhancing the quality of care and outcomes for patients with TAAD in low- and middle-income countries such as China. Firstly, the medical institution will need to expedite the scheduling of emergency surgery and better coordinate patient transfer since TAAD is a life-threatening condition and emergency services are available mostly in major cities. Secondly, local medical institutions should start building emergency rescue capacities to ensure that patients receive timely rescue and proper medical management, and more specialized surgeons will need to be trained to manage an increasingly elderly and acute TAAD population. In addition, limitations of the present study should be acknowledged. Firstly, there was heterogeneity in the Chinese and US databases. The NIS database lacked detailed patient medical information to further compare laboratory indicators, surgical procedures, etc. Moreover, Chinese patient data were limited to one province and represented challenges in terms of representativeness. The future inclusion of a broader range of Chinese patients will be considered for more detailed comparison. Secondly, the identification of patients with TAAD in the NIS was based on ICD-9 and ICD-10 codes, with pre-existing algorithms on the former converted to the latter. Although there were no abnormal fluctuations in the number of patients over the years, the accuracy and sensitivity of identification still needed further verification. In addition, the study duration was not the same for the US and Chinese cohorts, with the Chinese cohort having a longer study duration. This was mainly limited by the availability of data in the US. Conclusion TAAD patients in China were approximately five years younger compared to those in the US. There seemed to be no significant difference between the Chinese and US cohorts in terms of in-hospital mortality and overall perioperative complications. The length of stay among Chinese patients was approximately twice that of the US counterparts, while the total hospital cost was less than half that of the US cohort. Abbreviations TAAD Type A aortic dissection SD Standard deviation SE Standard error aOR Adjusted odds ratio CI Confidence interval IRAD International Registry of Acute Aortic Dissection TASR Type A open surgical repair LOS Length of stay NIS National Inpatient Sample HCUP Hospital Cost and Utilization Project TBSR Type B open surgical repair TEVAR Thoracic endovascular aortic repair ICD-9 International Classification of Diseases, Ninth Revision IQR Interquartile range OR Odds ratio HR Hazard ratio Declarations Data availability declaration The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. Funding declaration This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Competing Interest declaration This research was supported by China Pharmaceutical University Research Project and Nanjing First Hospital. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. References Clouse WD, Hallett JW Jr, Schaff HV, Spittell PC, Rowland CM, Ilstrup DM, et al. Acute aortic dissection: population-based incidence compared with degenerative aortic aneurysm rupture. Mayo Clin Proc, 2004. 79(2): p. 176-80. MéFJáros I, Mórocz J, FJlávi J, Schmidt J, Tornóci L, Nagy L, et al. Epidemiology and clinicopathology of aortic dissection. Chest, 2000. 117(5): p. 1271-8. Mody PS, Wang Y, Geirsson A, Kim N, Desai MM, Gupta A, et al. Trends in aortic dissection hospitalizations, interventions, and outcomes among medicare beneficiaries in the United States, 2000-2011. Circ Cardiovasc Qual Outcomes, 2014. 7(6): p. 920-8. Zhu Y, Lingala B, Baiocchi M, Tao JJ, Toro Arana V, Khoo JW, et al. Type A Aortic Dissection-Experience Over 5 Decades: JACC Historical Breakthroughs in Perspective. J Am Coll Cardiol, 2020. 76(14): p. 1703-1713. Abe T, Yamamoto H, Miyata H, Motomura N, Tokuda Y, Tanemoto K, et al. Patient trends and outcomes of surgery for type A acute aortic dissection in Japan: an analysis of more than 10 000 patients from the Japan Cardiovascular Surgery Database. Eur J Cardiothorac Surg, 2020. 57(4): p. 660-667. Inoue Y, Matsuda H, Uchida K, Komiya T, Koyama T, Yoshino H, et al. Analysis of Acute Type A Aortic Dissection in Japan Registry of Aortic Dissection (JRAD). Ann Thorac Surg, 2020. 110(3): p. 790-798. Pape LA, Awais M, Woznicki EM, Suzuki T, Trimarchi S, Evangelista A, et al. Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection: 17-Year Trends From the International Registry of Acute Aortic Dissection. J Am Coll Cardiol, 2015. 66(4): p. 350-8. Zimmerman KP, Oderich G, Pochettino A, Hanson KT, Habermann EB, Bower TC, et al. Improving mortality trends for hospitalization of aortic dissection in the National Inpatient Sample. J Vasc Surg, 2016. 64(3): p. 606-615.e1. O'Hara D, McLarty A, Sun E, Itagaki S, Tannous H, Chu D, et al. Type-A Aortic Dissection and Cerebral Perfusion: The Society of Thoracic Surgeons Database Analysis. Ann Thorac Surg, 2020. 110(5): p. 1461-1467. Boening A, Karck M, Conzelmann LO, Easo J, Krüger T, Rylski B, et al. German Registry for Acute Aortic Dissection Type A: Structure, Results, and Future Perspectives. Thorac Cardiovasc Surg, 2017. 65(2): p. 77-84. Benedetto U, Sinha S, Dimagli A, Cooper G, Mariscalco G, Uppal R, et al. Decade-long trends in surgery for acute Type A aortic dissection in England: A retrospective cohort study. Lancet Reg Health Eur, 2021. 7: p. 100131. Benedetto U, Dimagli A, Kaura A, Sinha S, Mariscalco G, Krasopoulos G, et al. Determinants of outcomes following surgery for type A acute aortic dissection: the UK National Adult Cardiac Surgical Audit. Eur Heart J, 2021. 43(1): p. 44-52. Sun L, Qi R, Zhu J, Liu Y, Zheng J. Total arch replacement combined with stented elephant trunk implantation: a new "standard" therapy for type a dissection involving repair of the aortic arch? Circulation, 2011. 123(9): p. 971-8. Wang W, Duan W, Xue Y, Wang L, Liu J, Yu S, et al. Clinical features of acute aortic dissection from the Registry of Aortic Dissection in China. J Thorac Cardiovasc Surg, 2014. 148(6): p. 2995-3000. Qiu J, Wu J, Xie E, Luo X, Chen JF, Gao W, et al. Surgical Management and Outcomes of the Aortic Root in Acute Type A Aortic Dissection. Ann Thorac Surg, 2020. 110(1): p. 136-143. Coccolini F, Perrone G, Chiarugi M, Di Marzo F, Ansaloni L, Scandroglio I, et al. Surgery in COVID-19 patients: operational directives. World J Emerg Surg, 2020. 15(1): p. 25. Evangelista A, Isselbacher EM, Bossone E, Gleason TG, Eusanio MD, Sechtem U, et al. Insights from the International Registry of Acute Aortic Dissection: A 20-Year Experience of Collaborative Clinical Research. Circulation, 2018. 137(17): p. 1846-1860. Li Y, Yang N, Duan W, Liu S, Yu S, Yi D. Acute aortic dissection in China. Am J Cardiol, 2012. 110(7): p. 1056-61. Parikh N, Trimarchi S, Gleason TG, Kamman AV, di Eusanio M, Myrmel T, et al. Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program. J Thorac Cardiovasc Surg, 2017. 153(4): p. S74-S79. Lee TC, Kon Z, Cheema FH, Grau-Sepulveda MV, Englum B, Kim S, et al. Contemporary management and outcomes of acute type A aortic dissection: An analysis of the STS adult cardiac surgery database. J Card Surg, 2018. 33(1): p. 7-18. Komatsu K, Takano T, Terasaki T, Wada Y, Seto T, Fukui D, et al. Surgical outcomes of acute type A aortic dissection in elderly patients. Ann Thorac Surg, 2014. 97(5): p. 1576-81. Piccardo A, Le Guyader A, Regesta T, Gariboldi V, Zannis K, Tapia M, et al. Octogenarians with uncomplicated acute type a aortic dissection benefit from emergency operation. Ann Thorac Surg, 2013. 96(3): p. 851-6. Caus T, Frapier JM, Giorgi R, Aymard T, Riberi A, Albat B, et al. Clinical outcome after repair of acute type A dissection in patients over 70 years-old. Eur J Cardiothorac Surg, 2002. 22(2): p. 211-7. Maze Y, Tokui T, Murakami M, Nakamura B, Inoue R, Hirano R, et al. Clinical outcomes of limited repair and conservative approaches in older patients with acute type A aortic dissection. J Cardiothorac Surg, 2022. 17(1): p. 78. Goldstone AB, Chiu P, Baiocchi M, Lingala B, Lee J, Rigdon J, et al. Interfacility Transfer of Medicare Beneficiaries With Acute Type A Aortic Dissection and Regionalization of Care in the United States. Circulation, 2019. 140(15): p. 1239-1250. Norton EL, Wu X, Kim KM, Fukuhara S, Patel HJ, Deeb GM, et al. Is hemiarch replacement adequate in acute type A aortic dissection repair in patients with arch branch vessel dissection without cerebral malperfusion? J Thorac Cardiovasc Surg, 2021. 161(3): p. 873-884.e2. Buntin, M.B. Access to postacute rehabilitation. Arch Phys Med Rehabil, 2007. 88(11): p. 1488-93. Bojko MM, Suhail M, Bavaria JE, Bueker A, Hu RW, Harmon J, et al. Midterm outcomes of emergency surgery for acute type A aortic dissection in octogenarians. J Thorac Cardiovasc Surg, 2022. 163(1): p. 2-12.e7. Li B, Ma WG, Liu YM, Sun LZ. Is extended arch replacement justified for acute type A aortic dissection? Interact Cardiovasc Thorac Surg, 2015. 20(1): p. 120-6. Tang GH, Malekan R, Yu CJ, Kai M, Lansman SL, Spielvogel D. Surgery for acute type A aortic dissection in octogenarians is justified. J Thorac Cardiovasc Surg, 2013. 145(3 Suppl): p. S186-90. Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterial.docx Cite Share Download PDF Status: Published Journal Publication published 14 Nov, 2024 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted Editorial decision: Revision requested 08 Jun, 2024 Reviews received at journal 12 May, 2024 Reviewers agreed at journal 06 May, 2024 Reviewers agreed at journal 05 May, 2024 Reviews received at journal 23 Apr, 2024 Reviewers agreed at journal 16 Apr, 2024 Reviewers agreed at journal 13 Apr, 2024 Reviewers invited by journal 11 Apr, 2024 Submission checks completed at journal 12 Mar, 2024 Editor assigned by journal 12 Mar, 2024 First submitted to journal 06 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4019578","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":278658511,"identity":"53bf6683-a9d9-4cd2-8173-ec0750b8af0d","order_by":0,"name":"Feng Jiang","email":"","orcid":"","institution":"School of International Business, China Pharmaceutical University","correspondingAuthor":false,"prefix":"","firstName":"Feng","middleName":"","lastName":"Jiang","suffix":""},{"id":278658512,"identity":"d82b3e20-9dc2-4f8f-9257-1a3fa98bf92d","order_by":1,"name":"Cunhua Su","email":"","orcid":"","institution":"Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Cunhua","middleName":"","lastName":"Su","suffix":""},{"id":278658513,"identity":"ba6f8b7e-8751-469e-9c9f-12ed2247f6b6","order_by":2,"name":"Michael Carmichael","email":"","orcid":"","institution":"Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Carmichael","suffix":""},{"id":278658514,"identity":"65be80be-7dc3-403b-aded-81234c26f21b","order_by":3,"name":"Yanfei Chen","email":"","orcid":"","institution":"School of International Business, China Pharmaceutical University","correspondingAuthor":false,"prefix":"","firstName":"Yanfei","middleName":"","lastName":"Chen","suffix":""},{"id":278658515,"identity":"d071c99b-c717-43ba-bc6d-3d3ef40a61a6","order_by":4,"name":"Ruijian Huang","email":"","orcid":"","institution":"School of International Business, China Pharmaceutical University","correspondingAuthor":false,"prefix":"","firstName":"Ruijian","middleName":"","lastName":"Huang","suffix":""},{"id":278658516,"identity":"a40e0dc0-39c6-4594-940b-1e9557d10dfc","order_by":5,"name":"Yue Xiao","email":"","orcid":"","institution":"School of International Business, China Pharmaceutical University","correspondingAuthor":false,"prefix":"","firstName":"Yue","middleName":"","lastName":"Xiao","suffix":""},{"id":278658517,"identity":"628abd8c-563e-40e4-88e8-32187b20ac65","order_by":6,"name":"Xin Chen","email":"","orcid":"","institution":"Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xin","middleName":"","lastName":"Chen","suffix":""},{"id":278658518,"identity":"d9fa7350-0e45-4556-aa2b-902f52f581da","order_by":7,"name":"Jifang Zhou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIie3PsQqCQBzH8b8ITorrLekrXDT2Mja5JDQ5VdwhXEvReuBL1NaoHOgizg0O9gBBYw1Cnq2htjXcd/jBDR/uDkCl+stS8mjX+RyMcYTydme/ENAkWZDRxKWCktdl4x/jPYZHKMCOycAVJKX0UOQBrwqs8VIAqpJ+okO6qy2WBSe0xLrFBGDk9ROj/T5tWOZjSZoxxGxJZLG11xFtDEGSTFgy5VW2Svelb6LrAHF5fqN3tnXtODrXz3Du2HyAAErkCnkfJN1LB7OJ3G1HVCqVSvW1N6JBSRDEuwl5AAAAAElFTkSuQmCC","orcid":"","institution":"School of International Business, China Pharmaceutical University","correspondingAuthor":true,"prefix":"","firstName":"Jifang","middleName":"","lastName":"Zhou","suffix":""}],"badges":[],"createdAt":"2024-03-06 06:29:54","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4019578/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4019578/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13019-024-03023-z","type":"published","date":"2024-11-14T15:57:34+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":52712321,"identity":"aed92096-e2b3-40bb-9992-32ad6fc9d468","added_by":"auto","created_at":"2024-03-14 20:10:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":127551,"visible":true,"origin":"","legend":"\u003cp\u003eStudy flow diagram of US (A) and Chinese (B) cohorts\u003c/p\u003e\n\u003cp\u003eAbbreviations: a. NIS, National Inpatient Sample; b. TBSR, type B open surgical repair; c. TEVAR, thoracic endovascular aortic repair; d. TASR, type A open surgical repair\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4019578/v1/b59112e88b1ba607ce00620d.png"},{"id":52713002,"identity":"42f1afd8-c05a-4231-8441-b6b22ec69122","added_by":"auto","created_at":"2024-03-14 20:18:06","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":165952,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of crude and standardized incidence rates of perioperative complication between the Chinese and UScohorts\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA.\u003c/strong\u003e Comparison of crude incidence rates of perioperative complication between the Chinese and UScohorts\u003c/p\u003e\n\u003cp\u003eAbbreviations: PNDS\u003cstrong\u003e:\u003c/strong\u003e Permanent neurological deficits; TNDS: Temporary neurological deficits\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eB.\u003c/strong\u003e Comparison of standardized incidence rates of perioperative complication between the Chinese and UScohorts\u003c/p\u003e\n\u003cp\u003eAbbreviations: PNDS\u003cstrong\u003e:\u003c/strong\u003e Permanent neurological deficits; TNDS: Temporary neurological dysfunction\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4019578/v1/ba789a8bcbc659b688588a59.png"},{"id":52712319,"identity":"4234f0f9-e859-4594-a6cd-9cb558eba0e2","added_by":"auto","created_at":"2024-03-14 20:10:06","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":297549,"visible":true,"origin":"","legend":"\u003cp\u003eUnadjusted (A) and adjusted (B) predictive factors associated with overall survival in Chinese type A aortic Dissection cohort\u003c/p\u003e\n\u003cp\u003eA. Unadjusted predictive factors associated with overall \u0026nbsp;\u0026nbsp;survival\u003c/p\u003e\n\u003cp\u003eFootnotes:\u003c/p\u003e\n\u003cp\u003e*Only total \u0026nbsp;\u0026nbsp;arch or ascending/ hemi-arch were used in TAAD patients\u003c/p\u003e\n\u003cp\u003e**TAAD \u0026nbsp;\u0026nbsp;patients were treated with total arch or ascending/hemi-arch in combination \u0026nbsp;\u0026nbsp;with at least one of the following operations: Aortic valve replacement, Root \u0026nbsp;\u0026nbsp;replacement, Aortic valvuloplasty, Coronary artery bypass grafting, Bypass \u0026nbsp;\u0026nbsp;surgery, Mitral valve replacement or plasty and Pacemaker implantation\u003c/p\u003e\n\u003cp\u003eB. Adjusted predictive factors associated with overall \u0026nbsp;\u0026nbsp;survival\u003c/p\u003e\n\u003cp\u003eFootnotes:\u003c/p\u003e\n\u003cp\u003e*Only total \u0026nbsp;\u0026nbsp;arch or ascending/ hemi-arch were used in TAAD patients\u003c/p\u003e\n\u003cp\u003e**TAAD \u0026nbsp;\u0026nbsp;patients were treated with total arch or ascending/hemi-arch in combination \u0026nbsp;\u0026nbsp;with at least one of the following operations: Aortic valve replacement, Root \u0026nbsp;\u0026nbsp;replacement, Aortic valvuloplasty, Coronary artery bypass grafting, Bypass \u0026nbsp;\u0026nbsp;surgery, Mitral valve replacement or plasty and Pacemaker implantation\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4019578/v1/d86ac78f725065a514309eb1.png"},{"id":69274991,"identity":"7cb4da36-71a7-437b-bc2a-7a5930c99da2","added_by":"auto","created_at":"2024-11-18 16:43:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1924399,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4019578/v1/ec2aadc4-9c6d-441b-9c89-9b78be94e3b1.pdf"},{"id":52712322,"identity":"976dd555-fe08-4467-899f-b6571ddc91ae","added_by":"auto","created_at":"2024-03-14 20:10:06","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":1101483,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-4019578/v1/b8fb8e9352c52621530a1a99.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Contemporary Comparative Surgical Outcomes of Type A Aortic Dissection in US and China: an Analysis of the National Inpatient Sample Database and a Chinese Multi-Institutional Registry","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe burden posed by aortic dissection, specifically type A aortic dissection (TAAD), has been noteworthy due to its sudden onset, requiring immediate surgical interventions, and leading to substantial mortality rates. However, the mortality rate has been observed to vary significantly across different countries.\u003csup\u003e1-4\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eIndications for TAAD surgery as well as associate prognosis could vary across industrialized countries. In Japan, the incidence of operative mortality was found to be between 9%-11%,\u003csup\u003e5, 6\u003c/sup\u003e while in the International Registry of Acute Aortic Dissection (IRAD), the rate was recorded to be as high as 18%-25%.\u003csup\u003e7\u003c/sup\u003e In the United States, the mortality rate ranged from 15%-20%,\u003csup\u003e8, 9\u003c/sup\u003e while in Germany, it was 16.9%\u003csup\u003e10\u003c/sup\u003e and in the United Kingdom, the rate was between 15%-23%.\u003csup\u003e11, 12\u003c/sup\u003e The differences in patient demographic and clinical characteristics, as well as the discrepancies in the provision of high-quality surgical services between countries, may have contributed to the unequal clinical outcomes between industrialized and middle-income countries such as China. Mortality rates for relevant studies in China in the same period ranged from 5%-11%, and a higher proportion of younger patients with TAAD might partly explain the lower mortality rates.\u003csup\u003e13-15\u003c/sup\u003e Furthermore, the mortality rate has gradually decreased over the past decade due to better postoperative care and continuously improving surgical operations.\u003csup\u003e4, 7-12\u003c/sup\u003e Nevertheless, current data on comparative outcomes remained limited, especially during the period of disruption to life-saving surgical services worldwide caused by the COVID-19 pandemic.\u003csup\u003e16\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe prevention and mitigation of perioperative complications were vital initiatives that aim to enhance the outcomes of type A open surgical repair (TASR). However, the available literature demonstrated a dearth of studies focusing on comparing the incidence rates and trends of perioperative complications across different nations.\u003csup\u003e6-12\u003c/sup\u003e Regrettably, current studies predominantly discussed the state of TAAD in specific geographic areas or nations, with the exception of the International Registry of Acute Aortic Dissection, which has not evaluated the specific conditions of TAAD patients in diverse countries.\u003csup\u003e7, 17\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eTherefore, the aim of this study was to compare the contemporary trends in in-hospital mortality and perioperative complications between US and Chinese patients with TAAD. To understand the shifting patterns of surgical management over time and to estimate the length of stay (LOS) and costs in real-world setting.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eData Source\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData sources included the US National Inpatient Sample (NIS) databases (2015-2019) and inpatient data from multiple centers in China (2012-2021). At first, the Hospital Cost and Utilization Project’s consists of a series of databases and associated software tools, created by a federal-state-industry collaboration and funded by the Agency for Health Research and Quality. Within\u0026nbsp;Hospital Cost and Utilization Project, the NIS serves as the largest publicly accessible claims database, capturing 20% of inpatient data across the United States.\u003c/p\u003e\n\u003cp\u003eOn the other hand, Chinese multicenter data on TAAD were collected from 11 medical institutions in Jiangsu Province. A range of patient characteristics, including demographics, in-hospital mortality and related complications, and the type of operation performed were systematically recorded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman ethics and consent to participate declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe experimental protocol was established, according to the ethical guidelines of the Helsinki Declaration and was approved by the Human Ethics Committee of the institutional review board of the China Pharmaceutical University. Since the data were deidentified, the requirement for informed consent was therefore waived.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe final analytical dataset consisted of 3,121 patients with TAAD who received surgical interventions during their index admission in the US and China during the study period. In the US cohort, we used a validated algorithm to determine types of aortic dissection.\u003csup\u003e3, 8\u003c/sup\u003ePatients received surgical management were categorized into three groups: type A open surgical repair (TASR), type B open surgical repair (TBSR) and thoracic endovascular aortic repair (TEVAR). We initially used\u0026nbsp;ICD-9 to find procedure codes for dissection repair: resection of aorta, abdominal or thoracic vessels with replacement, resection of aorta or other thoracic vessels with anastomosis, or repair of blood vessel with synthetic patch graft or unspecified type of patch graft; procedure codes for cardiac surgery: cardioplegia, valve repair, or operations on vessels of the heart; and repeated the previous action using ICD-10. Patients with procedure codes for dissection repair and cardiac surgery were categorized as a TASR. Eligible patients were at least 18 years old at admission and had at least one ICD-9-CM or ICD-10-CM code indicative of aortic dissection. We subsequently excluded individuals from the study cohort who possessed unknown vital status at the time of discharge, exhibited indications of an aortic aneurysm, or underwent transfer on the day of admission. Relevant International Classification of Diseases codes were referred to in \u003cstrong\u003eSupplemental Table 1\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eIn the Chinese TAAD cohort, patients with only endovascular or medical management or younger than 18 were excluded. We extracted relevant clinical variables from the patient registries of the hospitals, including patient demographics, clinical symptoms and signs, imaging findings, outcomes, and cause of death.\u0026nbsp;We also continuously tracked the survival status and prognosis of some patients through telephone interviews.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcomes measures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur primary outcomes included in-hospital mortality and rates of complications. We also evaluated the length of hospitalization and healthcare costs for patients with TAAD in the United States and China. Further, we analyzed the surgical management patterns in the Chinese TAAD cohort and factors associated with long-term survival.\u003c/p\u003e\n\u003cp\u003eTo directly compare the outcomes of Chinese and US patients, we used the demographic distributions extracted from the 2010 US census data to standardize the mortality and other indicators of the Chinese and US cohorts. Baseline characteristics were expressed as frequencies and percentages for categorical variables and medians (interquartile range, IQR) for continuous variables. Differences in baseline characteristics were compared by χ2 or rank sum test, as appropriate. Kaplan-Meier analysis was used to assess overall survival, and a multivariate Cox proportional hazards model was utilized to identify factors associated with overall mortality. All statistical tests were two-sided, with a P\u0026lt;0.05 indicating statistical significance. Data were analyzed using R version 3.5.1 and SAS 9.4.\u003c/p\u003e"},{"header":"Result","content":"\u003cp\u003eThe final cohorts included 3,121 inpatient admissions, with 2,048 from the United States and 1,073 from China (\u003cstrong\u003eFigure 1\u003c/strong\u003e). In the Chinese multi-institution registry, patients were monitored post-discharge until death, loss to follow-up, or until the end of the study period (Dec 31st, 2021). the median (IQR) follow-up duration was 2.00 (1.58-2.75) years (\u003cstrong\u003eSupplemental Figure 1\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBaseline characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe baseline characteristics of the Chinese and US patients who underwent TAAD surgery throughout the study period were demonstrated in \u003cstrong\u003eTable 1\u003c/strong\u003e. The Chinese cohort was found to be younger, and had a lower proportion of women and higher weekend admissions than the US cohort (21.0% vs. 31.2%, P\u0026lt;0.05; 28.5% vs. 23.1%, P\u0026lt;0.05). Two cohorts also differed significantly in terms of racial status and insurance types. Notably, several comorbidities in the US cohort were more common than those in the Chinese cohort, such as type 2 diabetes, dyslipidemia, coronary artery disease and heart failure. On the other hand, a higher proportion of Chinese patients suffered from hypertension, chronic liver disease, stroke, and Marfan syndrome compared to the US counterparts. Overall, the prevalence rate of comorbidities was higher in the US cohort.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Baseline descriptive demographic and clinical characteristics of the cohorts\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e\u003cstrong\u003eUS NIS cohort\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=\u003c/strong\u003e\u003cstrong\u003e2048\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u003cstrong\u003eChinese cohort\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=1\u003c/strong\u003e\u003cstrong\u003e073\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge at admission\u003c/strong\u003e, (\u003cem\u003eyrs,\u003c/em\u003e %\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eMean (\u0026plusmn;SE/SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e59.8\u0026plusmn;0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e53.9\u0026plusmn;12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e60.3 (49.8-70.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e54 (46-63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge group\u003c/strong\u003e (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003e\u0026le;49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e23.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e36.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003e50-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e23.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e30.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003e60-69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e25.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e22.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003e70-79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e20.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003e80+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale sex\u003c/strong\u003e (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e31.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e25.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e0.0003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003e\u003cstrong\u003eYear of admission\u0026nbsp;\u003c/strong\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003e2012-2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e22.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e22.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003e2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e18.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e19.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e18.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003e2019-2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e21.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e52.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003e\u003cstrong\u003eRace/ethnicity\u003c/strong\u003e (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eNon-Hispanic white\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e66.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eAfrican American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e18.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eHispanic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eAsian, Pacific Islander\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eNative American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eOther/unknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuartile of median income\u0026nbsp;\u003c/strong\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eQuartile 1 (less wealthy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e26.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eQuartile 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e23.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eQuartile 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e24.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eQuartile 4 (wealthier)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e25.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003e\u003cstrong\u003eInsurance type\u003c/strong\u003e (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003ePublic insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e54.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e54.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003ePrivate Insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e36.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eSelf-pay/Others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e45.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeekend admission\u003c/strong\u003e (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e23.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e28.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e0.0009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003e\u003cstrong\u003eChronic conditions\u003c/strong\u003e (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eType 2 diabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e0.0012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e66.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e77.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eDyslipidemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e31.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eChronic kidney disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eCoronary artery disease\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e19.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eHeart failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e20.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e14.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eChronic liver disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eStroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eChronic obstructive pulmonary disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e16.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eAtrial fibrillation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e23.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eObesity*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e18.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eMarfan syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003e\u003cstrong\u003eChar\u003c/strong\u003e\u003cstrong\u003el\u003c/strong\u003e\u003cstrong\u003eson comorbidity index\u003c/strong\u003e (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003e0-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e57.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003e3-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e31.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e32.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003e5+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e54.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e9.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFootnotes:\u003c/p\u003e\n\u003cp\u003e* Obesity status was determined using the estimated body mass index (BMI) at admission, with BMI equal or above\u0026nbsp;30\u0026nbsp;considered as obese.\u003c/p\u003e\n\u003cp\u003eAbbreviations: NIS, national inpatient sample; SE standard error; SD, standard deviation; IQR, inter\u0026nbsp;quartile range\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMortality and perioperative complications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the study period, in-hospital mortality for two cohorts decreased modestly, and the Chinese cohort seemed to have a better performance in this regard (\u003cstrong\u003eTable 2 and Table 3\u003c/strong\u003e;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eOR, 0.84; 95% CI, 0.70-0.997). After accounting for greater mortality risks among the elderly patients, the standardized in-hospital mortality rates were comparable. Furthermore, mortality was not significantly different in the fully adjusted model (OR, 1.16; 95% CI, 0.69-1.97).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRenal complications were more prevalent in Chinese patients, and this finding was constant regardless of models (\u003cstrong\u003eFigure 2 and Table 3\u003c/strong\u003e; OR, 2.00; 95% CI, 1.25-3.19). Permanent neurological deficits were less common in the Chinese cohort than temporary neurological dysfunction, but the converse was true in the US cohort (OR, 0.51; 95% CI, 0.34-0.77; OR, 1.41; 95% CI, 1.01-1.98). The incidences of cardiac and respiratory complications were most prevalent, accounting for about half of all cases, and there was no significant difference between the US and Chinese cohorts (OR, 1.19; 95% CI, 0.77-1.85; OR, 0.61; 95% CI, 0.36-1.04). Similarly, there was no significant difference in overall complications (OR, 1.07; 95% CI, 0.52-2.18). Additionally, the trend of complication rates in the Chinese cohort showed greater volatility, while that in the US cohort was relatively stable (\u003cstrong\u003eSupplemental Figure 2\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Observed crude and adjusted rates of in-hospital patient outcomes and associated costs in two cohorts\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"97%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcomes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e2012-2015\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e2016\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e2017\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e2018\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e2019-202\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude estimates (US)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e(N=\u003c/strong\u003e\u003cstrong\u003e2048\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e(N=\u003c/strong\u003e\u003cstrong\u003e460\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e(N=\u003c/strong\u003e\u003cstrong\u003e376\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e(N=\u003c/strong\u003e\u003cstrong\u003e402\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e(N=\u003c/strong\u003e\u003cstrong\u003e375\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e(N=\u003c/strong\u003e\u003cstrong\u003e435\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003ein-hospital mortality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e15.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e17.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e17.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e12.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e15.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e14.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003ein-hospital mortality(age:80+)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e24.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e27.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e19.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e30.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e21.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e20.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLOS, in days (median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e9.4 (6.0-15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e9.0 (5.8-14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e9.3 (6.2-15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e9.7 (6.0-15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e9.1 (5.6-16.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e10.3 (6.2-17.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eProlonged stay*\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWaiting time, in days\u0026nbsp;\u003c/strong\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e73.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e70.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e73.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e72.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e73.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e76.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e17.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e16.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e16.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e2+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e11.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCosts, in1,000 US dollar\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e74.5 (51.0-112.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e68.3 (50.0-99.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e70.0\u0026nbsp;(50.9-109.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e74.2 (51.6-110.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e75.4 (49.6-109.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e83.7 (54.1-134.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eRespiratory complications\u003csup\u003e\u0026nbsp;a\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e43.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e48.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e40.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e42.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e46.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e39.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eCardiac complications\u003csup\u003e\u0026nbsp;b\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e53.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e59.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e52.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e52.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e53.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e49.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eRenal complications\u003csup\u003e\u0026nbsp;c\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e9.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003ePermanent neurological deficits\u003csup\u003e\u0026nbsp;d\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e9.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e12.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eTemporary neurological\u0026nbsp;dysfunction\u003csup\u003e\u0026nbsp;e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eInfectious complications\u003csup\u003e\u0026nbsp;f\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e25.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e25.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e25.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e25.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e24.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e26.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eOverall complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e77.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e80.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e76.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e76.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e78.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e75.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude estimates (China)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e(N=\u003c/strong\u003e\u003cstrong\u003e1073\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e(N=\u003c/strong\u003e\u003cstrong\u003e243\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e(N=\u003c/strong\u003e\u003cstrong\u003e72\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e(N=\u003c/strong\u003e\u003cstrong\u003e90\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e(N=\u003c/strong\u003e\u003cstrong\u003e108\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e(N=\u003c/strong\u003e\u003cstrong\u003e560)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003ein-hospital mortality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e14.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e12.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLOS, in days (median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e20\u0026nbsp;(16-26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e21 (17-26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e21.5\u0026nbsp;(19-25.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e21.5 (18-28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e20\u0026nbsp;(15-24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e20 (15-27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eProlonged stay*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e17.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e18.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e13.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e18.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWaiting time, in days\u0026nbsp;\u003c/strong\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e57.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e38.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e52.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e60.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e67.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e64.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e24.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e30.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e27.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e28.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e22.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e21.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e2+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e17.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e30.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e19.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e10.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCosts, in 1,000 US dollar\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e31.1 (27.4-36.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e29.6 (26.4-33.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e30.1 (27.7-36.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e33.4 (29.8-40.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e32.6 (28.5-36.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e31.2 (27.4-39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eRespiratory complications\u003csup\u003e\u0026nbsp;a\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e47.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e51.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e55.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e60.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e44.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e44.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eCardiac complications\u003csup\u003e\u0026nbsp;b\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e41.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e22.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e37.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e42.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e36.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e51.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eRenal complications\u003csup\u003e\u0026nbsp;c\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e17.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e25.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e28.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e23.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e14.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003ePermanent neurological deficits\u003csup\u003e\u0026nbsp;d\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eTemporary neurological\u0026nbsp;dysfunction\u003csup\u003e\u0026nbsp;e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e16.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eInfectious complications\u003csup\u003e\u0026nbsp;f\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e28.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e32.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e29.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e23.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e27.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eOverall complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e68.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e65.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e76.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e71.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e63.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e69.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge- and sex- standardized estimates (US)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003ein-hospital mortality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLOS, in days (median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e10 (6-16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e6 (9-15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e10 (7-16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e10 (6-16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e10 (6-17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e11 (7-18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eProlonged stay*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCosts, in 1,000 US dollar (median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e74.6 (51.0-112.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e68.7 (49.6-100.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e70.1 (50.9-109.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e74.4 (51.7-110.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e75.5 (49.6-110.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e83.7 (54.1-136.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eRespiratory complications\u003csup\u003e\u0026nbsp;a\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e25.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e30.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e25.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e22.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e31.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e22.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eCardiac complications\u003csup\u003e\u0026nbsp;b\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e32.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e32.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e28.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e29.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e30.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e35.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eRenal complications\u003csup\u003e\u0026nbsp;c\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003ePermanent neurological deficits\u003csup\u003e\u0026nbsp;d\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eTemporary neurological\u0026nbsp;dysfunction\u003csup\u003e\u0026nbsp;e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eInfectious complications\u003csup\u003e\u0026nbsp;f\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e14.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e15.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e14.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e15.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eOverall complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e48.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e49.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e45.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e44.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e49.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e50.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge- and sex- standardized estimates (China)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003ein-hospital mortality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e11.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e11.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLOS, in days\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e20\u0026nbsp;(16-26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e21 (17-26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e21.5 (19-25.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e21.5 (18-28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e20\u0026nbsp;(15-24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e20 (15-27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eProlonged stay*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e16.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e9.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e19.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCosts, in 1,000 US dollar\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e31.1 (27.4-36.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e29.6 (26.4-33.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e30.1 (27.7-36.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e33.4 (29.8-40.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e32.6 (28.5-36.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e31.7 (27.4-39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eRespiratory complications\u003csup\u003e\u0026nbsp;a\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e31.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e36.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e31.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e30.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e22.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e28.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eCardiac complications\u003csup\u003e\u0026nbsp;b\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e30.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e18.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e26.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e19.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e20.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e32.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eRenal complications\u003csup\u003e\u0026nbsp;c\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e16.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e12.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003ePermanent neurological deficits\u003csup\u003e\u0026nbsp;d\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eTemporary neurological\u0026nbsp;dysfunction\u003csup\u003e\u0026nbsp;e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e8.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eInfectious complications\u003csup\u003e\u0026nbsp;f\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e20.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e26.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e17.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eOverall complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e50.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e53.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e45.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e37.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e33.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e45.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFootnotes:\u003c/p\u003e\n\u003cp\u003e*Prolonged stay was defined as admissions with length of stay equal or above 30 days.\u003c/p\u003e\n\u003cp\u003ea Respiratory complications included hypoxia, pneumonia, prolonged ventilation (\u0026gt;12h), postoperative reintubation, acute respiratory distress syndrome and respiratory failure.\u003c/p\u003e\n\u003cp\u003eb Cardiac complications included low cardiac output syndrome, cardiac arrest, postoperative arrhythmia, heart conduction disturbance, perioperative myocardial infarction, mitral insufficiency, aortic insufficiency, tricuspid insufficiency, perivalvular leakage, pericardial effusion and cardiac tamponade.\u003c/p\u003e\n\u003cp\u003ec Renal complications included acute kidney injury and renal failure requiring renal replacement therapy.\u003c/p\u003e\n\u003cp\u003ed Permanent neurological deficits included stroke, paraplegia, spinal cord complications and sensory disorders.\u003c/p\u003e\n\u003cp\u003ee Temporary neurologic dysfunction included transient ischemic attack and delirium.\u003c/p\u003e\n\u003cp\u003ef Infectious complications included bacteremia, sepsis, wound infection, infections of mediastinum, pulmonary infection/pneumonia, urinary tract infection, endocarditis, pericarditis; skin/soft tissue infection and infection of unknown site.\u003c/p\u003e\n\u003cp\u003eAbbreviations: IQR, inter quartile range; LOS, length of stay.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Comparative outcomes between two cohorts on in-hospital mortality, prolonged length of stay and perioperative complications\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcomes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u003cstrong\u003eChina\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(Comparator, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u003cstrong\u003eUS\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(Reference, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbsolute differences\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude Model\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eIn-hospital mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e13.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e15.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e-0.02 (-0.05, 0.004)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e0.84 (0.70, 0.997)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eProlonged stay*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e17.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e7.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;0.10 (0.07, 0.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e2.55 (1.88, 3.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eAny perioperative complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e68.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e77.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e-0.09 (-0.12, -0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e0.65 (0.42, 1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpecific complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eRespiratory complications\u003csup\u003e\u0026nbsp;a\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e47.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e43.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e0.04 (0.002, 0.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e1.19 (0.77, 1.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eCardiac complications\u003csup\u003e\u0026nbsp;b\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e41.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e53.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e-0.13 (-0.16,\u0026nbsp;-0.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e0.61 (0.36, 1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eRenal complications\u003csup\u003e\u0026nbsp;c\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e17.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e9.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e0.08 (0.05, 0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e2.00 (1.25, 3.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003ePermanent neurological deficits\u003csup\u003e\u0026nbsp;d\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e6.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e11.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e-0.06 (-0.08,\u0026nbsp;-0.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e0.51 (0.34, 0.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eTemporary neurological\u0026nbsp;dysfunction\u003csup\u003e\u0026nbsp;e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e10.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e7.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e0.02 (-0.01, 0.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e1.41 (1.01, 1.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eInfectious complications\u003csup\u003e\u0026nbsp;f\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e28.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e25.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e0.03 (0.01, 0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e1.16 (0.93, 1.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted Model 1\u003c/strong\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eIn-hospital mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e11.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e9.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e1.00 (0.81,\u0026nbsp;1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eProlonged stay*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e4.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e16.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e2.61 (1.93, 3.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eAny perioperative complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e48.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e50.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e0.76 (0.48, 1.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted Model 2\u003c/strong\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eIn-hospital mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e11.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e9.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e1.06 (0.74, 1.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eProlonged stay*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e4.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e16.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e1.78 (1.20, 2.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eAny perioperative complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e48.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e50.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e0.75 (0.45, 1.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted Model 3\u003c/strong\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003ein-hospital mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e11.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e9.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e1.10 (0.74, 1.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eProlonged stay*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e4.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e16.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e2.18 (1.38, 3.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eAny perioperative complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e48.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e50.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e1.10 (0.56, 2.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted Model\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e4\u003c/strong\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003ein-hospital mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e11.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e9.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e1.16 (0.69, 1.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eProlonged stay*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e4.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e16.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e2.42 (1.29, 4.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.95876288659794%\"\u003e\n \u003cp\u003eAny perioperative complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\"\u003e\n \u003cp\u003e48.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e50.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e1.07 (0.52, 2.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFootnotes:\u003c/p\u003e\n\u003cp\u003e*Prolonged stay was defined as admissions with length of stay equal or above 30 days.\u003c/p\u003e\n\u003cp\u003e**Model 1 was adjusted for sex and age at admission; Model 2 was adjusted for sex, age, and race/ethnicity status; Model\u0026nbsp;3\u0026nbsp;was adjusted for\u0026nbsp;all\u0026nbsp;demographic and clinical characteristics; Model\u0026nbsp;4\u0026nbsp;was adjusted for\u0026nbsp;all\u0026nbsp;demographic and clinical characteristics\u0026nbsp;and\u0026nbsp;characteristics of healthcare facilities.\u003c/p\u003e\n\u003cp\u003ea Respiratory complications included hypoxia, pneumonia, prolonged ventilation (\u0026gt;12h), postoperative reintubation, acute respiratory distress syndrome and respiratory failure.\u003c/p\u003e\n\u003cp\u003eb Cardiac complications included low cardiac output syndrome, cardiac arrest, postoperative arrhythmia, heart conduction disturbance, perioperative myocardial infarction, mitral insufficiency, aortic insufficiency, tricuspid insufficiency, perivalvular leakage, pericardial effusion and cardiac tamponade.\u003c/p\u003e\n\u003cp\u003ec Renal complications included acute kidney injury and renal failure requiring renal replacement therapy.\u003c/p\u003e\n\u003cp\u003ed Permanent neurological deficits included stroke, paraplegia, spinal cord complications and sensory disorders.\u003c/p\u003e\n\u003cp\u003ee Temporary neurologic dysfunction included transient ischemic attack and delirium.\u003c/p\u003e\n\u003cp\u003ef Infectious complications included bacteremia, sepsis, wound infection, infections of mediastinum, pulmonary infection/pneumonia, urinary tract infection, endocarditis, pericarditis; skin/soft tissue infection and infection of unknown site.\u003c/p\u003e\n\u003cp\u003eAbbreviations: OR, odds ratio.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLength of stay and health care cost\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter comparing length of stay and costs between the Chinese and US cohorts, it was found that the Chinese cohort maintained a longer length of stay and lower total costs, even after accounting for standardized length of stay and costs (\u003cstrong\u003eTable 2\u003c/strong\u003e). After adjusting for relevant covariates, the Chinese cohort still had lower overall in-hospital costs (\u003cstrong\u003eTable 4\u003c/strong\u003e; median net increase, -49.9; 95% CI, -55.4--44.5). We further analyzed the Chinese cohort and found that patients who underwent total arch replacement surgery spent significantly more during their hospitalization than those who underwent ascending or hemi-arch replacement surgery (\u003cstrong\u003eSupplemental Table 5\u003c/strong\u003e). Meanwhile, the length of stay in the Chinese cohort was significantly longer than that in the US cohort (median net increase, 10.4; 95% CI, 9.2-11.5). Furthermore, we found the same tendency in prolonged stay (OR, 2.42; 95% CI, 1.29-4.56). On the other hand, related medical expenses in the United States continued to grow, while those in China remained stable during the study period. Additionally, the US cohort tended to have a shorter waiting time from admission to surgical procedures.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e. Comparative outcomes between two cohorts on length of stay and overall costs\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.734693877551024%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcomes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u003cstrong\u003eChina\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(Comparator)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\"\u003e\n \u003cp\u003e\u003cstrong\u003eUS\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(Reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian Net Increase\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ein LOS/Cost (Days/$)\u0026nbsp;\u003c/strong\u003e(95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.734693877551024%\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuantile regression model\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.734693877551024%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude Model\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.734693877551024%\"\u003e\n \u003cp\u003eLOS\u0026nbsp;(median, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e20\u0026nbsp;(16-26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\"\u003e\n \u003cp\u003e9.4 (6.0-15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\"\u003e\n \u003cp\u003e10.0 (10.0-32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.734693877551024%\"\u003e\n \u003cp\u003eCosts,\u0026nbsp;in 1,000 US dollar\u0026nbsp;(median, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e31.1 (27.4-36.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\"\u003e\n \u003cp\u003e74.5 (51.0-112.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\"\u003e\n \u003cp\u003e-43.4 (-44.3, -42.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.734693877551024%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted Model 1**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.734693877551024%\"\u003e\n \u003cp\u003eLOS (median, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e20\u0026nbsp;(16-26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\"\u003e\n \u003cp\u003e9.4 (6.0-15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\"\u003e\n \u003cp\u003e7.1 (5.2-9.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.734693877551024%\"\u003e\n \u003cp\u003eCosts,\u0026nbsp;in 1,000 US dollar\u0026nbsp;(median, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e31.1 (27.4-36.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\"\u003e\n \u003cp\u003e74.5 (51.0-112.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\"\u003e\n \u003cp\u003e-42.4 (-43.3, -41.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.734693877551024%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted Model 2**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.734693877551024%\"\u003e\n \u003cp\u003eLOS (median, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e20\u0026nbsp;(16-26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\"\u003e\n \u003cp\u003e9.4 (6.0-15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\"\u003e\n \u003cp\u003e10.2 (9.3-11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.734693877551024%\"\u003e\n \u003cp\u003eCosts,\u0026nbsp;in 1,000 US dollar\u0026nbsp;(median, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e31.1 (27.4-36.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\"\u003e\n \u003cp\u003e74.5 (51.0-112.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\"\u003e\n \u003cp\u003e-51.9 (-54.3, -50.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.734693877551024%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted Model 3**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.734693877551024%\"\u003e\n \u003cp\u003eLOS (median, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e20\u0026nbsp;(16-26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\"\u003e\n \u003cp\u003e9.4 (6.0-15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\"\u003e\n \u003cp\u003e10.8 (9.7-11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.734693877551024%\"\u003e\n \u003cp\u003eCosts,\u0026nbsp;in 1,000 US dollar\u0026nbsp;(median, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e31.1 (27.4-36.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\"\u003e\n \u003cp\u003e74.5 (51.0-112.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\"\u003e\n \u003cp\u003e-45.3 (-48.0, -40.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.734693877551024%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted Model 4**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.734693877551024%\"\u003e\n \u003cp\u003eLOS (median, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e20\u0026nbsp;(16-26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\"\u003e\n \u003cp\u003e9.4 (6.0-15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\"\u003e\n \u003cp\u003e10.4 (9.2-11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.734693877551024%\"\u003e\n \u003cp\u003eCosts,\u0026nbsp;in 1,000 US dollar\u0026nbsp;(median, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\"\u003e\n \u003cp\u003e31.1 (27.4-36.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\"\u003e\n \u003cp\u003e74.5 (51.0-112.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\"\u003e\n \u003cp\u003e-49.9 (-55.4, -44.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFootnotes:\u003c/p\u003e\n\u003cp\u003e*Prolonged stay was defined as admissions with length of stay equal or above 30 days.\u003c/p\u003e\n\u003cp\u003e**Model 1 was adjusted for sex and age at admission; Model 2 was adjusted for sex, age, and race/ethnicity status; Model\u0026nbsp;3\u0026nbsp;was adjusted for\u0026nbsp;all\u0026nbsp;demographic\u0026nbsp;characteristics; Model\u0026nbsp;4\u0026nbsp;was adjusted for\u0026nbsp;all\u0026nbsp;demographic and clinical characteristics\u0026nbsp;and\u0026nbsp;characteristics of healthcare facilities.\u003c/p\u003e\n\u003cp\u003eAbbreviations: IQR, inter\u0026nbsp;quartile range; LOS, length of stay\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLong-term survival\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe preliminary results showed that age, burden of comorbidity (measured by Charlson comorbidity index), type 2 diabetes, chronic kidney disease, coronary heart disease, heart failure, stroke, liver disease and surgical complexity were all significantly related to the long-term survival of TAAD patients after surgery (\u003cstrong\u003eFigure 3, Supplemental Figure 3 and Supplemental Table 3\u003c/strong\u003e). For example, compared with patients under 50 years old, the long-term mortality rate of patients over 70 years old increased by 187% (HR, 2.87; 95% CI, 1.92-4.29). After adjusting the relevant variables, and the type and complexity of surgery still had a significant impact on the long-term survival rate. Among them, the choice of total arch replacement surgery or compound surgery was associated with lower long-term survival rate. We further investigated operative management in the Chinese cohort (\u003cstrong\u003eSupplemental Table 4\u003c/strong\u003e). Among analyzed TAAD patients, 80.7% underwent total arch replacement surgery, while 32.8% subjects underwent two or more types of surgical procedures.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we compared the characteristics and outcomes of patients undergoing surgery for TAAD by using the US NIS database and the Chinese multicenter registry. The Chinese cohort represented the largest contemporary Chinese TAAD cohort to undergo surgical management,\u003csup\u003e13, 15, 18\u003c/sup\u003eand we collected follow-up data to analyze prognostic factors associated with long-term survival. As previously reported, Chinese patients were relatively younger and appeared to have lower comorbid burdens.\u003csup\u003e13-15, 18\u003c/sup\u003eThe in-hospital mortality rates observed in US and Chinese patients were consistent with recent literature.\u003csup\u003e8-10, 12, 19\u003c/sup\u003eNevertheless, other cohorts showed higher or lower mortality rates owing to differences in study period, country and demographic characteristics.\u003csup\u003e6, 7, 11, 13-15, 18\u003c/sup\u003e The waiting time from admission to surgery was significantly longer among the Chinese cohort compared to the US. Meanwhile, despite the longer length of stay in China, overall costs were lower compared to US hospitalizations for TAAD.\u003c/p\u003e\n\u003cp\u003eMortality rates in the US and Chinese cohorts remained stable during the study period, while differences between the two countries persisted. There were five possible explanations for the difference in mortality rates before standardized. Firstly, the age distribution of the patients differed across the two nations. Specifically, elderly patients over the age of 80 accounted for only 0.9% of the Chinese cohort while composing 6.5% of the US cohort. Given the heightened mortality risk for individuals in this age group,\u003csup\u003e9, 19, 20\u003c/sup\u003e questions remained unresolved regarding whether surgical intervention would benefit elderly patients with acute TAAD.\u003csup\u003e21-24\u003c/sup\u003e In China, considering that the reported in-hospital mortality and postoperative complications were both very high for patients aged above 80 years old at diagnosis, octogenarians with acute TAAD were more likely to defer surgery due to perceived worsened survival relative to medical management.\u003csup\u003e22, 24\u003c/sup\u003eSecondly, most of the patients in the Chinese cohort were transferred to hospitals with greater accreditation for treatment, and prior studies have proven the mortality rate of TAAD patients was directly proportional to the hospital surgery volume.\u003csup\u003e25\u003c/sup\u003eThirdly, many patients with acute TAAD might die before admission or diagnosis in China, owing to insufficient emergency rescue forces.\u003csup\u003e14\u003c/sup\u003e Fourth, although no data was available from the NIS, according to a relatively new study from the University of Michigan, hemiarch replacement was 57.8% compared to aggressive arch replacement.\u003csup\u003e26\u003c/sup\u003eConversely, most Chinese surgeons thought that total arch replacement combined with stented elephant trunk implantation was a “standard” therapy for TAAD involving the repair of the aortic arch, which was 70.8% (80% in this study) compared to conventional surgical repair.\u003csup\u003e13\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe present study found comparable rates of complications between the United States and China, yet the US cohort demonstrated a more consistent long-term trend in the occurrence of various complications. This finding might reflect the greater maturity of treatment strategies and overall healthcare delivery in the United States. On the contrary, the incidence rates of complications fluctuated greatly in Chinese patients, notably the rate of cardiac complications, which might be ascribed to an increase in the complexity of operations performed and the number of patients undergoing surgery for TAAD related to the establishment of Chest Pain Center. With increasing numbers of Chest pain Centers established across Jiangsu Province, the accessibility of emergency surgical services for local patients with complex TAAD has been drastically improved.\u003c/p\u003e\n\u003cp\u003eOur study corroborated that the US centers had higher turn-over rates as demonstrated by significantly shorter length of stay. Nevertheless, US centers charged for much higher medical expenses. The reasons for the difference in length of stay were complex and multifactorial. One reason was that the length of stay of patients was strictly limited by insurance companies in the US, while the cost was paid by basic medical insurance or out-of-pocket in China. Another reason was that discharged patients had the option of being transferred to post-acute care settings in the US, such as skilled nursing facility, rehabilitation or nursing home,\u003csup\u003e27\u003c/sup\u003e which was quite different from the vast majority of Chinese patients returning home after discharge. While the most likely reason for the difference in overall costs could have been inexpensive surgical treatment and lower administrative expenditures in Chinese public health system.\u003c/p\u003e\n\u003cp\u003eThe results of multivariate analysis indicated that the severity of associated complications and the choice of TAAD surgical methods were related to the long-term survival of patients, and the impact of age on that was not significant after variable adjustment. Bojko et al. reported that heart failure, postoperative renal failure and stroke were significant independent predictors of all-cause mortality, paralleling the results of the current study.\u003csup\u003e28\u003c/sup\u003eWe also found total arch replacement or single surgery tended to be associated with reduced long-term survival. Nevertheless, the effects of different aortic dissection operations were controversial internationally.\u003csup\u003e29\u003c/sup\u003e The sample size of patients with ascending aortic replacement or hemiarch replacement patients may have limited the statistical power to detect disparities. Furthermore, the choice of surgical strategy depended on the patient's condition and was not randomized. Therefore, further research was needed to prove the superiority of total arch replacement or hemiarch replacement. Additionally, our study revealed that advanced age did not exhibit a statistically significant correlation with long-term survival, which was consistent with previous studies on the surgical repair of acute TAAD in elderly patients.\u003csup\u003e30\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study provided valuable insights into potential avenues for enhancing the quality of care and outcomes for patients with TAAD in low- and middle-income countries such as China. Firstly, the medical institution will need to expedite the scheduling of emergency surgery and better coordinate patient transfer since TAAD is a life-threatening condition and emergency services are available mostly in major cities. Secondly, local medical institutions should start building emergency rescue capacities to ensure that patients receive timely rescue and proper medical management, and more specialized surgeons will need to be trained to manage an increasingly elderly and acute TAAD population.\u003c/p\u003e\n\u003cp\u003eIn addition, limitations of the present study should be acknowledged. Firstly, there was heterogeneity in the Chinese and US databases. The NIS database lacked detailed patient medical information to further compare laboratory indicators, surgical procedures, etc. Moreover, Chinese patient data were limited to one province and represented challenges in terms of representativeness. The future inclusion of a broader range of Chinese patients will be considered for more detailed comparison. Secondly, the identification of patients with TAAD in the NIS was based on ICD-9 and ICD-10 codes, with pre-existing algorithms on the former converted to the latter. Although there were no abnormal fluctuations in the number of patients over the years, the accuracy and sensitivity of identification still needed further verification. In addition, the study duration was not the same for the US and Chinese cohorts, with the Chinese cohort having a longer study duration. This was mainly limited by the availability of data in the US.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eTAAD patients in China were approximately five years younger compared to those in the US. There seemed to be no significant difference between the Chinese and US cohorts in terms of in-hospital mortality and overall perioperative complications. The length of stay among Chinese patients was approximately twice that of the US counterparts, while the total hospital cost was less than half that of the US cohort.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTAAD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eType A aortic dissection\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStandard deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStandard error\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eaOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAdjusted odds ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eConfidence interval\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIRAD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInternational Registry of Acute Aortic Dissection\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTASR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eType A open surgical repair\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLength of stay\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNIS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNational Inpatient Sample\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHCUP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHospital Cost and Utilization Project\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTBSR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eType B open surgical repair\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTEVAR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eThoracic endovascular aortic repair\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eICD-9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInternational Classification of Diseases, Ninth Revision\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIQR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInterquartile range\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOdds ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHazard ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported by China Pharmaceutical University Research Project and Nanjing First Hospital. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eClouse WD, Hallett JW Jr, Schaff HV, Spittell PC, Rowland CM, Ilstrup DM, et al. Acute aortic dissection: population-based incidence compared with degenerative aortic aneurysm rupture. Mayo Clin Proc, 2004. 79(2): p. 176-80.\u003c/li\u003e\n\u003cli\u003eM\u0026eacute;FJ\u0026aacute;ros I, M\u0026oacute;rocz J, FJl\u0026aacute;vi J, Schmidt J, Torn\u0026oacute;ci L, Nagy L, et al. Epidemiology and clinicopathology of aortic dissection. Chest, 2000. 117(5): p. 1271-8.\u003c/li\u003e\n\u003cli\u003eMody PS, Wang Y, Geirsson A, Kim N, Desai MM, Gupta A, et al. Trends in aortic dissection hospitalizations, interventions, and outcomes among medicare beneficiaries in the United States, 2000-2011. Circ Cardiovasc Qual Outcomes, 2014. 7(6): p. 920-8.\u003c/li\u003e\n\u003cli\u003eZhu Y, Lingala B, Baiocchi M, Tao JJ, Toro Arana V, Khoo JW, et al. Type A Aortic Dissection-Experience Over 5 Decades: JACC Historical Breakthroughs in Perspective. J Am Coll Cardiol, 2020. 76(14): p. 1703-1713.\u003c/li\u003e\n\u003cli\u003eAbe T, Yamamoto H, Miyata H, Motomura N, Tokuda Y, Tanemoto K, et al. Patient trends and outcomes of surgery for type A acute aortic dissection in Japan: an analysis of more than 10\u0026thinsp;000 patients from the Japan Cardiovascular Surgery Database. Eur J Cardiothorac Surg, 2020. 57(4): p. 660-667.\u003c/li\u003e\n\u003cli\u003eInoue Y, Matsuda H, Uchida K, Komiya T, Koyama T, Yoshino H, et al. Analysis of Acute Type A Aortic Dissection in Japan Registry of Aortic Dissection (JRAD). Ann Thorac Surg, 2020. 110(3): p. 790-798.\u003c/li\u003e\n\u003cli\u003ePape LA, Awais M, Woznicki EM, Suzuki T, Trimarchi S, Evangelista A, et al. Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection: 17-Year Trends From the International Registry of Acute Aortic Dissection. J Am Coll Cardiol, 2015. 66(4): p. 350-8.\u003c/li\u003e\n\u003cli\u003eZimmerman KP, Oderich G, Pochettino A, Hanson KT, Habermann EB, Bower TC, et al. Improving mortality trends for hospitalization of aortic dissection in the National Inpatient Sample. J Vasc Surg, 2016. 64(3): p. 606-615.e1.\u003c/li\u003e\n\u003cli\u003eO\u0026apos;Hara D, McLarty A, Sun E, Itagaki S, Tannous H, Chu D, et al. Type-A Aortic Dissection and Cerebral Perfusion: The Society of Thoracic Surgeons Database Analysis. Ann Thorac Surg, 2020. 110(5): p. 1461-1467.\u003c/li\u003e\n\u003cli\u003eBoening A, Karck M, Conzelmann LO, Easo J, Kr\u0026uuml;ger T, Rylski B, et al. German Registry for Acute Aortic Dissection Type A: Structure, Results, and Future Perspectives. Thorac Cardiovasc Surg, 2017. 65(2): p. 77-84.\u003c/li\u003e\n\u003cli\u003eBenedetto U, Sinha S, Dimagli A, Cooper G, Mariscalco G, Uppal R, et al. Decade-long trends in surgery for acute Type A aortic dissection in England: A retrospective cohort study. Lancet Reg Health Eur, 2021. 7: p. 100131.\u003c/li\u003e\n\u003cli\u003eBenedetto U, Dimagli A, Kaura A, Sinha S, Mariscalco G, Krasopoulos G, et al. Determinants of outcomes following surgery for type A acute aortic dissection: the UK National Adult Cardiac Surgical Audit. Eur Heart J, 2021. 43(1): p. 44-52.\u003c/li\u003e\n\u003cli\u003eSun L, Qi R, Zhu J, Liu Y, Zheng J. Total arch replacement combined with stented elephant trunk implantation: a new \u0026quot;standard\u0026quot; therapy for type a dissection involving repair of the aortic arch? Circulation, 2011. 123(9): p. 971-8.\u003c/li\u003e\n\u003cli\u003eWang W, Duan W, Xue Y, Wang L, Liu J, Yu S, et al. Clinical features of acute aortic dissection from the Registry of Aortic Dissection in China. J Thorac Cardiovasc Surg, 2014. 148(6): p. 2995-3000.\u003c/li\u003e\n\u003cli\u003eQiu J, Wu J, Xie E, Luo X, Chen JF, Gao W, et al. Surgical Management and Outcomes of the Aortic Root in Acute Type A Aortic Dissection. Ann Thorac Surg, 2020. 110(1): p. 136-143.\u003c/li\u003e\n\u003cli\u003eCoccolini F, Perrone G, Chiarugi M, Di Marzo F, Ansaloni L, Scandroglio I, et al. Surgery in COVID-19 patients: operational directives. World J Emerg Surg, 2020. 15(1): p. 25.\u003c/li\u003e\n\u003cli\u003eEvangelista A, Isselbacher EM, Bossone E, Gleason TG, Eusanio MD, Sechtem U, et al. Insights from the International Registry of Acute Aortic Dissection: A 20-Year Experience of Collaborative Clinical Research. Circulation, 2018. 137(17): p. 1846-1860.\u003c/li\u003e\n\u003cli\u003eLi Y, Yang N, Duan W, Liu S, Yu S, Yi D. Acute aortic dissection in China. Am J Cardiol, 2012. 110(7): p. 1056-61.\u003c/li\u003e\n\u003cli\u003eParikh N, Trimarchi S, Gleason TG, Kamman AV, di Eusanio M, Myrmel T, et al. Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program. J Thorac Cardiovasc Surg, 2017. 153(4): p. S74-S79.\u003c/li\u003e\n\u003cli\u003eLee TC, Kon Z, Cheema FH, Grau-Sepulveda MV, Englum B, Kim S, et al. Contemporary management and outcomes of acute type A aortic dissection: An analysis of the STS adult cardiac surgery database. J Card Surg, 2018. 33(1): p. 7-18.\u003c/li\u003e\n\u003cli\u003eKomatsu K, Takano T, Terasaki T, Wada Y, Seto T, Fukui D, et al. Surgical outcomes of acute type A aortic dissection in elderly patients. Ann Thorac Surg, 2014. 97(5): p. 1576-81.\u003c/li\u003e\n\u003cli\u003ePiccardo A, Le Guyader A, Regesta T, Gariboldi V, Zannis K, Tapia M, et al. Octogenarians with uncomplicated acute type a aortic dissection benefit from emergency operation. Ann Thorac Surg, 2013. 96(3): p. 851-6.\u003c/li\u003e\n\u003cli\u003eCaus T, Frapier JM, Giorgi R, Aymard T, Riberi A, Albat B, et al. Clinical outcome after repair of acute type A dissection in patients over 70 years-old. Eur J Cardiothorac Surg, 2002. 22(2): p. 211-7.\u003c/li\u003e\n\u003cli\u003eMaze Y, Tokui T, Murakami M, Nakamura B, Inoue R, Hirano R, et al. Clinical outcomes of limited repair and conservative approaches in older patients with acute type A aortic dissection. J Cardiothorac Surg, 2022. 17(1): p. 78.\u003c/li\u003e\n\u003cli\u003eGoldstone AB, Chiu P, Baiocchi M, Lingala B, Lee J, Rigdon J, et al. Interfacility Transfer of Medicare Beneficiaries With Acute Type A Aortic Dissection and Regionalization of Care in the United States. Circulation, 2019. 140(15): p. 1239-1250.\u003c/li\u003e\n\u003cli\u003eNorton EL, Wu X, Kim KM, Fukuhara S, Patel HJ, Deeb GM, et al. Is hemiarch replacement adequate in acute type A aortic dissection repair in patients with arch branch vessel dissection without cerebral malperfusion? J Thorac Cardiovasc Surg, 2021. 161(3): p. 873-884.e2.\u003c/li\u003e\n\u003cli\u003eBuntin, M.B. Access to postacute rehabilitation. Arch Phys Med Rehabil, 2007. 88(11): p. 1488-93.\u003c/li\u003e\n\u003cli\u003eBojko MM, Suhail M, Bavaria JE, Bueker A, Hu RW, Harmon J, et al. Midterm outcomes of emergency surgery for acute type A aortic dissection in octogenarians. J Thorac Cardiovasc Surg, 2022. 163(1): p. 2-12.e7.\u003c/li\u003e\n\u003cli\u003eLi B, Ma WG, Liu YM, Sun LZ. Is extended arch replacement justified for acute type A aortic dissection? Interact Cardiovasc Thorac Surg, 2015. 20(1): p. 120-6.\u003c/li\u003e\n\u003cli\u003eTang GH, Malekan R, Yu CJ, Kai M, Lansman SL, Spielvogel D. Surgery for acute type A aortic dissection in octogenarians is justified. J Thorac Cardiovasc Surg, 2013. 145(3 Suppl): p. S186-90.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cohort study, In-hospital mortality, Perioperative complication, Type A aortic dissection, Surgery","lastPublishedDoi":"10.21203/rs.3.rs-4019578/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4019578/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eTo investigate the contemporary comparative inpatient prognosis among US and Chinese patients with type A aortic dissection (TAAD).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Data from Chinese multi-institutional TAAD registry and the US National Inpatient Sample databases were analyzed. We used multivariable logistic regression models to compare in-hospital mortality and perioperative complication rates between the US and China. Length of stay and overall costs were fitted with quantile regression models. Independent prognostic factors associated with post-operative survival were assessed via Cox proportional hazards models.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Among 3,121 eligible TAAD patients, 1,073 were from China (25.0% female; mean ± SD age, 53.9±12.4) and 2,048 were from the US (31.2% female; mean ± SE age, 59.8 ± 0.3). During the study period, the in-hospital mortality rates in China and the US were 15.5% and 13.3%, yet the difference was insignificant after adjustment (aOR, 1.16; 95% CI, 0.69-1.97). While there was no significant difference in overall perioperative complications (aOR, 1.07; 95% CI, 0.52-2.18), the patterns of complications differed between two cohorts. While Chinese TAAD patients experienced significantly longer duration of hospitalization (median difference, +10.4 days; 95% CI, 9.2-11.5), the US TAAD cohort had significantly greater overall hospitalization costs (49.9; 95% CI, 55.4-44.5, in 1000 USD).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Notwithstanding significant differences in demographic and clinical characteristics, TAAD patients from China and the US demonstrated comparable in-hospital mortality and overall perioperative complication rates. Future initiatives should focus on expanding surgical eligibility to the elderly Chinese TAAD patients and optimizing the duration of hospitalization without undermining meaningful clinical outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003e: KY20220425-05, April 5th 25 2022\u003c/p\u003e","manuscriptTitle":"Contemporary Comparative Surgical Outcomes of Type A Aortic Dissection in US and China: an Analysis of the National Inpatient Sample Database and a Chinese Multi-Institutional Registry","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-14 20:10:02","doi":"10.21203/rs.3.rs-4019578/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-06-08T07:18:02+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-12T17:41:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"300972286025058055279552952766095060336","date":"2024-05-07T01:29:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"195683204826864905336286145456795316030","date":"2024-05-05T14:30:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-23T15:27:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1552634b-47fb-4e4b-a489-d693a1370cce","date":"2024-04-16T23:21:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"faa1d257-11c6-4822-892d-00df5a60e7fd","date":"2024-04-13T18:46:03+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-04-11T17:44:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-12T09:00:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-12T09:00:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cardiothoracic Surgery","date":"2024-03-06T06:24:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0d5741fc-b6bf-45ec-925d-63189c549813","owner":[],"postedDate":"March 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-11-18T16:02:05+00:00","versionOfRecord":{"articleIdentity":"rs-4019578","link":"https://doi.org/10.1186/s13019-024-03023-z","journal":{"identity":"journal-of-cardiothoracic-surgery","isVorOnly":false,"title":"Journal of Cardiothoracic Surgery"},"publishedOn":"2024-11-14 15:57:34","publishedOnDateReadable":"November 14th, 2024"},"versionCreatedAt":"2024-03-14 20:10:02","video":"","vorDoi":"10.1186/s13019-024-03023-z","vorDoiUrl":"https://doi.org/10.1186/s13019-024-03023-z","workflowStages":[]},"version":"v1","identity":"rs-4019578","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4019578","identity":"rs-4019578","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}