J. Tashiro1, C. J. Allen1, J. Rey2, E. A. Perez1, C. M. Thorson1, B. Wang1, J. E. Sola1 1University Of Miami,Division Of Pediatric Surgery, DeWitt-Daughtry Family Department Of Surgery,Miami, FL, USA 2University Of Miami,Division Of Vascular And Endovascular Surgery, DeWitt-Daughtry Family Department Of Surgery,Miami, FL, USA
Introduction: Thoracic aortic dissection is a rare occurrence in childhood and mostly associated with connective tissue disorders or congenital abnormalities. We examined the characteristics associated with aortic dissection and predictors of survival.
Methods: The Kids’ Inpatient Database was searched for cases of thoracic aortic dissection (ICD-9-CM codes 441.01, 441.03) occurring in patients <20 years old between 1997 and 2009. Clinical characteristics, as well as determinants of survival were analyzed using standard statistical methods. All cases were weighted to represent national estimates.
Results: One hundred sixty-eight cases of thoracic aortic dissection were identified during the study period. Overall survival was 83%. Average length of stay was 15.9±16.9 days, with charges 181,867.92±211,985.00 USD. Thoracic dissection tended to affect adolescents aged 15-19 years (67%), males (76%), and Caucasians (56%) most frequently. Most patients were privately insured (64%) and treated at urban teaching centers (86%). Commonly associated diagnoses were hypertension (18%), Marfan syndrome (15%), and aortic valve disorders (8%). When repair was performed, open repair were more frequent (88%) than endovascular repair (6%). Hemorrhage was the most common complication (15%). Multiple determinants of survival were found. Girls (Mortality odds ratio: 0.21 [0.05, 0.91]) fared better than boys, p=0.023. Patients with Medicaid (OR: 2.84 [1.21, 6.69]) had higher mortality vs. privately insured, p=0.014. Income, race, and hospital characteristics, and type of repair were not significant predictors, even upon subanalyses of surgical and non-surgical groups separately.
Conclusion: Dissection of the thoracic aorta is a rare, but significant condition affecting the pediatric population. Most repairs are performed using open technique. Payer status and gender are predictors of survival in these cases.
