A population-based analysis of endovascular versus open thoracic aortic aneurysm repair.
OBJECTIVE
The perioperative outcomes of open surgical and endovascular repair of intact thoracic aortic aneurysms (TAAs) during the last 3 months of 2005 were compared using a national administrative database.


METHODS
The Nationwide Inpatient Sample was used to identify patients undergoing open aneurysm repair (OAR) or endovascular TAA repair (TEVAR) from October 1 to December 31, 2005. Patient demographic data, length of stay, hospital charges, patient disposition, and mortality were examined. Where appropriate, univariate tests of association used the chi(2) test, and multiple logistic regression analysis was used to determine predictors of in-hospital mortality, complications, and discharge status.


RESULTS
A total of 1030 patients underwent open TAA repair and 267 underwent TEVAR. There was no significant difference in mortality between OAR and TEVAR (adjusted odds ratio [OR], 1.2; 95% confidence interval [CI], 0.73-2.12), although OAR patients were more likely to have cardiac, respiratory, and hemorrhagic complications. Patients undergoing TEVAR were more likely to be discharged to home (adjusted OR, 6.37; 95% CI, 2.93-13.70) and had a decreased length of stay (5.7 days vs 9.9 days; P = .0015). The differences in hospital charges and costs were not significant.


CONCLUSIONS
Although further study is warranted, this study of a national sample suggests that endovascular TAA repair is safe in the short-term, associated with fewer cardiac, respiratory, and hemorrhagic complications, and requires a shorter hospital stay.
Orandi
Babak J
BJ
Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich., USA.
Dimick
Justin B
JB
Deeb
G Michael
GM
Patel
Himanshu J
HJ
Upchurch
Gilbert R
GR
D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000191:economics / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D019992:Databases as Topic; D005260:Female; D006331:Heart Diseases / Q000209:etiology; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010351:Patient Discharge; D011159:Population Surveillance; D019106:Postoperative Hemorrhage / Q000209:etiology; D012140:Respiratory Tract Diseases / Q000209:etiology; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000401:mortality