Y. Seo1, E. Aguayo1, K. Bailey1, Y. Sanaiha1, V. Dobaria2, P. Benharash1 1David Geffen School Of Medicine, University Of California At Los Angeles,Los Angeles, CA, USA 2University Of California – Los Angeles,Los Angeles, CA, USA
Introduction:
Thoracic aortic injuries (TAI) have traditionally been associated with high morbidity and mortality. Since its FDA approval in 2005, thoracic endovascular aortic repair (TEVAR) has emerged as a suitable alternative to open repair. However, use of TEVAR and impact on other treatment modalities at a national level remains ill defined. This study aims to analyze the national trends of hospital characteristics, patient characteristics, and resource utilization in the treatment of TAI.
Methods:
Patients admitted with TAI between 2005 and 2014 were identified in the National Inpatient Sample (NIS). Patients were identified as undergoing TEVAR, open surgery and non-operative management. The primary outcome was in-hospital mortality while secondary outcomes included complication, length of stay, and GDP-adjusted costs. Multivariate logistic regression accounting for comorbidities, concomitant injuries, and other interventions was used to determine predictors of mortality and receiving a particular treatment.
Results:
Of the 11,257 patients who were admitted for TAI during the study period, 33% received TEVAR, 2% open surgery, and 12% non-operative management. Trends in the use of various modalities are shown in Figure 1 with TEVAR having the largest growth (p<0.001). Compared to open surgery, TEVAR patients had higher rates of concomitant brain injury (17 vs 26%, p=0.01), pulmonary injury (21 vs 33%, p<0.001) and splenic injury (2 vs 4%, p=0.031). Patients were less likely to undergo TEVAR if they were female (OR=0.73, P=0.026), older than 85 (OR=0.29, P=0.019), had congestive heart failure (OR=0.27, P=0.014), or coronary artery disease (OR=0.34, P=0.035). In hospital mortality was greater for open surgeries (OR=3.06, p=0.003) and nonoperative management (OR=4.33, p<0.001) than TEVAR. Open had higher rates of cardiac complication (10 vs 4%, p<0.001). Mortality rate for TEVAR and nonoperative management did not change throughout the years but mortality for open surgery increased (p=0.04). Interestingly, the cost for admissions with TEVAR increased from $35K to $95K (p=0.004), while the cost for open surgery has steadily declined (p=0.031).
Conclusion:
Our findings indicate the rapid adoption of TEVAR over open surgery for management of TAI. TEVAR is associated with lower mortality and complication rates but has increased costs not otherwise explained by other patient factors. This warrant further studies into to change in cost and socioeconomic barriers to receiving optimal care.
