Thirty-Day Readmissions After Thoracic Endovascular Aortic Repair for Type B Aortic Dissection

Abstract

Management of type B aortic dissection (TBAD) with thoracic endovascular aortic repair (TEVAR) carries a significant resource burden for the admitting hospital, including costs related to 30-day readmissions. Our objective was to define the patient population for 30-day readmissions after TEVAR for aortic dissection and to identify risk factors, readmission reasons, and possible preventive measures to reduce this readmission rate. A retrospective review of a prospectively collected database of all TEVARs performed to treat TBAD at a quaternary-level institution was performed. Patients readmitted to any of the institution's nine acute care hospitals within 30 days were identified and analyzed to characterize the significant demographic, comorbid, operative, and medical factors associated with readmission. Between 2012 and 2019, 294 patients underwent TEVAR for treatment of acute (n = 95 [48.8%]), subacute (n = 37 [12.6%]), or chronic (n = 112 [38.2%]) TBAD. Of the 279 patients alive at discharge, 45 patients (16.1%) were readmitted within 30 days, with a mean time to readmission of 11.8 ± 8.9 days. Readmission primary diagnosis was most commonly aorta related (n = 13 [28.9%]) or heart related (n = 11 [24.4%]); other reasons included gastroenterologic (n = 6 [13.3%]), neurologic (n = 5 [11.1%]), pulmonary related (n = 4 [8.9%]), infectious (n = 3 [6.7%]), and nonclassified (n = 2 [4.4%]). Of 45 readmitted patients, 7 (15.5%) underwent a secondary intervention during the index readmission. Preoperative renal failure (creatinine concentration >1.5 mg/dL) was associated with an increased rate of 30-day readmission (31.1% vs 16.7%; P = .024), as was private insurance status (26.7% vs 13.7%; P = .029). Patients who underwent intentional left subclavian artery coverage (zone 2) or had visceral/renal stents implanted at the time of TEVAR trended toward higher 30-day readmission rates compared with patients undergoing descending thoracic aortic coverage (zone 3-5) only (46.7% vs 37.8% vs 15.6%; P = .088). Blood pressure range and heart rate range in the 24-hour period before discharge were not predictive of 30-day readmission. Pain status and creatinine level at discharge were also not associated with increased rate of 30-day readmission. A consequential number of patients require readmission within 30 days after surgical treatment of TBAD with TEVAR. Reasons for readmission are commonly aorta related and heart related and are associated with preoperative renal failure and insurance status. Increased case complexity, including coverage of the left subclavian artery or the need for visceral/renal stenting at the time of TEVAR, is an independent predictor of increased 30-day readmission rate. Effectiveness of medical impulse control was not associated with 30-day readmission. These data provide insight into the quality-oriented metrics associated with endovascular treatment of TBAD.