IP071. Readmission Patterns Following Diagnosis of Aortic Dissection, Intramural Hematoma and Penetrating Aortic Ulcer in a Population-Based Cohort From 1995 to 2015

Abstract

Aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU), carry significant early and late morbidity and mortality. These patients often undergo lifetime surveillance and require secondary interventions. However, few data exist regarding readmissions after initial diagnosis of these pathologies. The aim of this study was to assess the readmission patterns among a population-based cohort of patients with AD, IMH, and PAU. We reviewed all Olmsted County, Minnesota, residents (1995-2015) diagnosed with AD/IMH/PAU (n = 133). Patients who died acutely were excluded (n = 16). Medical charts were reviewed retrospectively to identify readmissions. They were classified as aortic or cardiovascular (CV) in nature. Cumulative incidence estimates were used to assess readmission with death as a competing risk. Kaplan-Meier estimates were used to assess long-term mortality. There were 117 patients included (55.6% AD, n = 65; 17.1% IMH, n = 20; 27.4% PAU, n = 32). Overall, 79 patients (67.5% of the entire cohort) had at least one readmission with a median time to first readmission of 143 days (interquartile range [IQR], 15-1244) from discharge. Aortic related readmissions occurred in 56.4% of all patients at a median of 171 days (IQR, 15-1213) and represented 83.5% of those with any readmission. CV readmissions occurred in 31.6% of all patients at a median of 861 days (IQR, 111-3006). The 2-, 4- and 10-year cumulative incidence of any readmission was 45%, 55%, and 69% and was similar across subgroups (P = .24). Additionally, the cumulative incidence of readmission for aortic and CV admissions at 2, 4, and 10 years was 38%, 46%, 59% and 15%, 20%, 28% and was similar across AD/IMH/PAU (P = .11 and P = .57). Overall survival at 2, 4, and 10 years was 84%, 75% and 50% and was also similar across subgroups (P = .45). Readmissions for AD/IMH/PAU are common during follow-up and many of them occur in the first year after diagnosis and are similar across subtypes. Aortic related readmissions occur in a majority of patients and tend to occur early. CV readmissions occur later in nearly one-third of patients as well. These data suggest a pattern of early intensive care for aortic complications and later care needs for cardiac events. Both of these should be targeted for improvements in the longitudinal care of patients with these complex aortic pathologies.