Population-based outcomes of open descending thoracic aortic aneurysm repair

Abstract

Objective: To evaluate national outcomes after open repair of descending thoracic aortic aneurysm (DTA).

Methods: The DTA repairs were identified from the NIS database from 1988-2003 by ICD9 codes for thoracic vascular resection and replacement (38.45) and a diagnosis of intact (441.1) or ruptured (441.2) thoracic aortic aneurysm; excluding thoraco-abdominal aneurysm, abdominal aortic aneurysm repair, cardioplegia, hypothermia, cardiac surgery, or aorta to carotid or subclavian bypass. Demographics and comorbidities were noted. Outcomes included in-hospital mortality, length of stay, and complications. Annual hospital surgical volume terciles (high, medium, and low) were quantified for the series and patients assigned accordingly. Outcomes were compared between intact and ruptured aneurysm characteristics as well as annual hospital volume. Predictors of peri-operative mortality were analyzed by multivariate logistic regression.

Results: A total of 2549 DTA repairs were identified (1976 intact, 573 ruptured). Mortality was 18% overall; 10% for intact (age <65 6.2%, 65-74 11.3%, >/=75 17.6%, P < .001), 45% for ruptured (age <65 33.3%, 65-74 47.1%, >/=75 52.4%, P < .001). Mortality decreased over the 15-year time-period (P < .0001). Mortality after intact repair was lower at a high volume hospital (HVH) (8%) than a low volume hospital (LVH) (13%) or medium volume hospital (MVH) (12%). Hospital volume tercile did not predict rupture mortality. Complications after intact DTA repair were coded in 42%; including respiratory (13%), cardiac (11%), acute renal failure (8%), stroke (3%), and neurologic (non-stroke) (2%). Complications were coded in 49% after ruptured DTA repair including respiratory (13%), cardiac (13%), acute renal failure (20%), stroke (3%), and neuro (non-stroke) (2%). Predictors of mortality (for all DTA repairs) were (odd ratio [OR], 95% confidence interval [CI]): age 65-74 vs age <65 (1.8, 1.4-2.4), age >/=75 vs age <65 (2.7, 2.0-3.6), rupture (6.3, 5.1-7.9), and LVH or MVH vs HVH (1.3, 1.1-1.7).

Conclusion: Mortality after open repair of DTA is high and complications are common. Mortality is dependent upon age, rupture status, and hospital surgical volume. Results of endovascular DTA repair should be compared using similar population-based data.