Trends in repair of intact and ruptured descending thoracic aortic aneurysms in the United States

A population-based analysis

Arman Kilic, Ashish S. Shah, James H. Black, Glenn J R Whitman, David D. Yuh, Duke E. Cameron, John Conte

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background To evaluate trends and outcomes of descending thoracic aortic aneurysm (DTAA) repair in the United States. Methods Adults undergoing DTAA repair between 1998 and 2008 were identified in the Nationwide Inpatient Sample. To limit confounding, patients with connective tissue disorders, aortic dissection, or thoracoabdominal aneurysms were excluded. Stratification was based on intact versus ruptured DTAA and open versus endovascular approach. Standardized annual rates of repair were calculated based on US Census Bureau population estimates. Logistic regression analysis incorporating multiple patient, operative, and hospital variables was used for risk adjustment. Results A total of 20,568 DTAA patients (intact, 17,780; ruptured, 2788) underwent repair (open, 15,265; endovascular, 5303). Patients undergoing repair in the more recent era had higher comorbidity burdens than those undergoing repair in the earlier era. Despite this, annual rates of repair for both intact and ruptured DTAAs increased significantly during the study period (intact, 2.2-10.6 per 1 million; ruptured, 0.8-1.3 per 1 million; P <.05), primarily because of increases in rates of endovascular repair in recent years. Operative mortality decreased from 10.3% to 3.1% for repairs of intact DTAAs (P <.001) and from 52.6% to 23.4% for ruptured DTAAs (P =.002). Endovascular repair was associated with reduced risk-adjusted mortality for both intact (odds ratio, 0.31; P <.001) and ruptured (odds ratio, 0.41; P =.001) DTAAs. Conclusions Although patients undergoing DTAA repair in the modern era have a higher comorbidity burden, rates of repair have increased and operative mortality has decreased, in part because of the increasing adoption of endovascular approaches.

Original languageEnglish (US)
Pages (from-to)1855-1860
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume147
Issue number6
DOIs
StatePublished - Jan 1 2014

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Thoracic Aortic Aneurysm
Population
Mortality
Comorbidity
Odds Ratio
Risk Adjustment
Censuses
Connective Tissue
Aneurysm
Dissection
Inpatients
Logistic Models
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Kilic, Arman ; Shah, Ashish S. ; Black, James H. ; Whitman, Glenn J R ; Yuh, David D. ; Cameron, Duke E. ; Conte, John. / Trends in repair of intact and ruptured descending thoracic aortic aneurysms in the United States : A population-based analysis. In: Journal of Thoracic and Cardiovascular Surgery. 2014 ; Vol. 147, No. 6. pp. 1855-1860.
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abstract = "Background To evaluate trends and outcomes of descending thoracic aortic aneurysm (DTAA) repair in the United States. Methods Adults undergoing DTAA repair between 1998 and 2008 were identified in the Nationwide Inpatient Sample. To limit confounding, patients with connective tissue disorders, aortic dissection, or thoracoabdominal aneurysms were excluded. Stratification was based on intact versus ruptured DTAA and open versus endovascular approach. Standardized annual rates of repair were calculated based on US Census Bureau population estimates. Logistic regression analysis incorporating multiple patient, operative, and hospital variables was used for risk adjustment. Results A total of 20,568 DTAA patients (intact, 17,780; ruptured, 2788) underwent repair (open, 15,265; endovascular, 5303). Patients undergoing repair in the more recent era had higher comorbidity burdens than those undergoing repair in the earlier era. Despite this, annual rates of repair for both intact and ruptured DTAAs increased significantly during the study period (intact, 2.2-10.6 per 1 million; ruptured, 0.8-1.3 per 1 million; P <.05), primarily because of increases in rates of endovascular repair in recent years. Operative mortality decreased from 10.3{\%} to 3.1{\%} for repairs of intact DTAAs (P <.001) and from 52.6{\%} to 23.4{\%} for ruptured DTAAs (P =.002). Endovascular repair was associated with reduced risk-adjusted mortality for both intact (odds ratio, 0.31; P <.001) and ruptured (odds ratio, 0.41; P =.001) DTAAs. Conclusions Although patients undergoing DTAA repair in the modern era have a higher comorbidity burden, rates of repair have increased and operative mortality has decreased, in part because of the increasing adoption of endovascular approaches.",
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Trends in repair of intact and ruptured descending thoracic aortic aneurysms in the United States : A population-based analysis. / Kilic, Arman; Shah, Ashish S.; Black, James H.; Whitman, Glenn J R; Yuh, David D.; Cameron, Duke E.; Conte, John.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 147, No. 6, 01.01.2014, p. 1855-1860.

Research output: Contribution to journalArticle

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T1 - Trends in repair of intact and ruptured descending thoracic aortic aneurysms in the United States

T2 - A population-based analysis

AU - Kilic, Arman

AU - Shah, Ashish S.

AU - Black, James H.

AU - Whitman, Glenn J R

AU - Yuh, David D.

AU - Cameron, Duke E.

AU - Conte, John

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N2 - Background To evaluate trends and outcomes of descending thoracic aortic aneurysm (DTAA) repair in the United States. Methods Adults undergoing DTAA repair between 1998 and 2008 were identified in the Nationwide Inpatient Sample. To limit confounding, patients with connective tissue disorders, aortic dissection, or thoracoabdominal aneurysms were excluded. Stratification was based on intact versus ruptured DTAA and open versus endovascular approach. Standardized annual rates of repair were calculated based on US Census Bureau population estimates. Logistic regression analysis incorporating multiple patient, operative, and hospital variables was used for risk adjustment. Results A total of 20,568 DTAA patients (intact, 17,780; ruptured, 2788) underwent repair (open, 15,265; endovascular, 5303). Patients undergoing repair in the more recent era had higher comorbidity burdens than those undergoing repair in the earlier era. Despite this, annual rates of repair for both intact and ruptured DTAAs increased significantly during the study period (intact, 2.2-10.6 per 1 million; ruptured, 0.8-1.3 per 1 million; P <.05), primarily because of increases in rates of endovascular repair in recent years. Operative mortality decreased from 10.3% to 3.1% for repairs of intact DTAAs (P <.001) and from 52.6% to 23.4% for ruptured DTAAs (P =.002). Endovascular repair was associated with reduced risk-adjusted mortality for both intact (odds ratio, 0.31; P <.001) and ruptured (odds ratio, 0.41; P =.001) DTAAs. Conclusions Although patients undergoing DTAA repair in the modern era have a higher comorbidity burden, rates of repair have increased and operative mortality has decreased, in part because of the increasing adoption of endovascular approaches.

AB - Background To evaluate trends and outcomes of descending thoracic aortic aneurysm (DTAA) repair in the United States. Methods Adults undergoing DTAA repair between 1998 and 2008 were identified in the Nationwide Inpatient Sample. To limit confounding, patients with connective tissue disorders, aortic dissection, or thoracoabdominal aneurysms were excluded. Stratification was based on intact versus ruptured DTAA and open versus endovascular approach. Standardized annual rates of repair were calculated based on US Census Bureau population estimates. Logistic regression analysis incorporating multiple patient, operative, and hospital variables was used for risk adjustment. Results A total of 20,568 DTAA patients (intact, 17,780; ruptured, 2788) underwent repair (open, 15,265; endovascular, 5303). Patients undergoing repair in the more recent era had higher comorbidity burdens than those undergoing repair in the earlier era. Despite this, annual rates of repair for both intact and ruptured DTAAs increased significantly during the study period (intact, 2.2-10.6 per 1 million; ruptured, 0.8-1.3 per 1 million; P <.05), primarily because of increases in rates of endovascular repair in recent years. Operative mortality decreased from 10.3% to 3.1% for repairs of intact DTAAs (P <.001) and from 52.6% to 23.4% for ruptured DTAAs (P =.002). Endovascular repair was associated with reduced risk-adjusted mortality for both intact (odds ratio, 0.31; P <.001) and ruptured (odds ratio, 0.41; P =.001) DTAAs. Conclusions Although patients undergoing DTAA repair in the modern era have a higher comorbidity burden, rates of repair have increased and operative mortality has decreased, in part because of the increasing adoption of endovascular approaches.

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