title: Thoracic aortic trauma: outcomes and hospital resource utilization after endovascular and open repair.
abstract: Thoracic endovascular aortic repair (TEVAR) has evolved as a treatment option for the management of thoracic aortic trauma as an alternative to open thoracic aortic repair (OTAR). Population-level outcomes are not known and were evaluated. Secondary data analysis of the 2005-2006 Nationwide Inpatient Sample data was performed, and 1,561 patients with thoracic aortic injury (mean age 44.8 +/- 18.8 years; men 77.2%) were identified. Of these, 510 underwent emergent surgical intervention: 240 OTAR (47%) and 270 TEVAR (53%). Males were more likely to undergo any surgery (77.2% vs 22.8%; p = .03). Hospital mortality after OTAR was greater compared to TEVAR (14.61% vs 7.43%; p = .009). OTAR patients were more likely to have pulmonary complications (37.8% vs 21.65; p < .0001) but were less likely to have stroke (2.1% vs 5.8%; p = .03) compared to TEVAR patients. After adjustment, OTAR patients remained more likely to die compared to TEVAR patients (OR 11.5; 95% CI 4.0-33.2). Hospital length of stay and hospital cost were significantly greater for OTAR than for TEVAR. An increase in patients with thoracic aortic injury undergoing repair was found (23.0% vs 40.3%; p < .0002). In trauma, TEVAR was associated with decreased hospital mortality, hospital use, and pulmonary complications but increased rates of stroke. Further implementation of TEVAR for management of thoracic aortic trauma may improve future outcomes and reduce hospital resource use.
authors.affiliation: Division of Vascular Surgery, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, One Robert Wood Johnson Place, New Brunswick, NJ 08903, USA.
authors.forename: Albeir Y
authors.initials: AY
authors.lastname: Mousa
authors.forename: Viktor Y
authors.initials: VY
authors.lastname: Dombrovskiy
authors.forename: Paul B
authors.initials: PB
authors.lastname: Haser
authors.forename: Alan M
authors.initials: AM
authors.lastname: Graham
authors.forename: Todd R
authors.initials: TR
authors.lastname: Vogel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000293:injuries / Q000601:surgery*; D016009:Chi-Square Distribution; D019992:Databases as Topic; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D005260:Female; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data*; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000191:economics; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D014947:Wounds and Injuries / Q000191:economics / Q000401:mortality / Q000601:surgery*; D055815:Young Adult