Aortic Surgery Outcomes of Marfan Syndrome and Ehlers-Danlos Syndrome Patients at Teaching and Non-teaching Hospitals

Abstract

Retrospective review of a National Inpatient Sample from 2000 to 2014. Of 3487 patients with Marfan syndrome (MFS; 97%) or Ehlers-Danlos syndrome (EDS; 3%) who underwent aortic aneurysm repair, 85% were performed at teaching hospitals. Approximately 66% were thoracic, 15% thoracoabdominal, and 18% abdominal aortic aneurysms (AAAs) in each group. Open surgical repair was performed in 95% of cases and endovascular repair (primarily for AAAs) in 5% of each group. Urgent or emergent repair was performed in approximately 44% of cases in each group. Patients at nonteaching hospitals were more likely to have a dissection (49% vs 38%) (P = .02). In a multivariable logistic regression model, there were no differences in perioperative mortality (5%), length of stay (8 days), or other complications between teaching and nonteaching hospitals. Of note, patients presenting with dissection were three times more likely to die than those without dissection, and the most common perioperative complication at both types of hospitals was hemorrhage in about 45% of patients. Although most patients with MFS and EDS who undergo aortic aneurysm repair do so at teaching hospitals, patients who undergo repair at nonteaching hospitals do not have worse mortality or morbidity despite a higher incidence of dissection.