Propensity score-matched analysis of open surgical and endovascular repair for type B aortic dissection

Abstract

Objective. To identify national outcomes of thoracic endovascular aortic repair (TEVAR) for type B aortic dissections (TBADs). Methods. The Nationwide Inpatient Sample database was examined from 2005 to 2008 using ICD-9 codes to identify patients with TBAD who underwent TEVAR or open surgical repair. We constructed separate propensity models for emergently and electively admitted patients and calculated mortality and complication rates for propensity score-matched cohorts of TEVAR and open repair patients. Results. In-hospital mortality was significantly higher following open repair than TEVAR (17.5% versus 10.8%, P = .045) in emergently admitted TBAD. There was no in-hospital mortality difference between open repair and TEVAR (5.6% versus 3.3%, P = .464) for elective admissions. Hospitals performing thirty or more TEVAR procedures annually had lower mortality for emergent TBAD than hospitals with fewer than thirty procedures. Conclusions. TEVAR produces better in-hospital outcomes in emergent TBAD than open repair, but further longitudinal analysis is required.

Figure 1

In-hospital mortality rates for emergently admitted TBAD patients undergoing TEVAR based on the annual hospital volume of TEVAR procedures performed. The following are the number of emergently admitted TBAD patients treated with endovascular repair in each TEVAR volume group: 1–4 (n = 225), 5–8 (n = 237), 9–14 (n = 217), 15–29 (n = 239), 30–55 (n = 241), greater than 55 (n = 167), less than 30 (n = 917), 30 or more (n = 408).