Abstract 12926: The Impact of Thoracic Aortic Aneurysm versus Dissection on Postoperative Outcomes After Thoracic Endovascular Aortic Repair

Abstract

Introduction: As thoracic endovascular aortic repair (TEVAR) is the standard of care for complicated Type B aortic dissection (TBAD) and descending thoracic aortic (DTA) aneurysm, it is critical to understand its outcomes and utilization. Hypothesis: Nationwide postoperative complications, admission costs, and 30- and 90-day readmissions after TEVAR are between TBAD and aneurysm. Methods: Codes from the International Classification of Diseases (ICD) 9 and 10 identified patients with a primary procedure code for TEVAR from 2010-2017 in the Nationwide Readmissions Database (with trend weights to generate national estimates). After ICD codes identified patients with thoracic or thoracoabdominal aortic dissection as well as aortic aneurysm, the two groups were compared. Mixed model logistic regression identified variables associated with readmission, treating individual hospital as a random effect. Results: An estimated 6594 patients underwent non-elective TEVAR, of which 4649 (70.5%) had TBAD and 1945 (29.5%) had aneurysm of the DTA. Patients with aneurysms were more likely to be older, be women, have cardiovascular disease, and have chronic pulmonary disease than patients with TBAD. In-hospital mortality was lower for aneurysm (5.7% vs. 10.9%, p<0.001) than TBAD. For patients with aneurysm, there was less stroke (4.6% vs. 7.1%), paraplegia (2.2% vs. 3.9%), acute kidney injury (18.2% vs. 34.5%), and mesenteric ischemia (2.0% vs. 5.8%) than TBAD. Patients with aneurysm had lower total cost of care during their index admission (48.0 vs. 65.2 x $1000) than TBAD. The proportion of 30-day and 90-day readmissions were similar across each group, with overall 30-day readmission being 23.6%, while 90-day readmission was 38.2%. On multivariable adjustment, aneurysm was not associated with increased odds of 30-day readmission (OR 1.02, 95% CI: 0.84, 1.25, p=0.820) or 90-day readmission (OR 0.97, 95% CI: 0.80, 1.19, p=0.780) compared to TBAD. Conclusions: While TBAD was associated with worse in-hospital mortality and higher incidence of complications, aortic disease was not associated with an increased odds of readmission through 90 days. However, the incidence of early readmission was substantial for patients undergoing non-elective TEVAR.