title: Open versus endovascular repair of thoracic aortic aneurysms: a Nationwide Inpatient Sample study.
abstract: OBJECTIVE
  Endovascular repair of descending thoracic aortic aneurysms has become an acceptable surgical option over the past decade. We sought to compare the results of open versus endovascular repair of thoracic aortic aneurysms (TEVAR) in the United States.
  
  
  METHODS
  The Nationwide Inpatient Sample (NIS) database was queried to identify all patients undergoing elective repair of a thoracic aortic aneurysm from 1998 to 2007 in the United States. Patient demographic data, preoperative comorbidities, and postoperative complications were recorded. Statistical analyses were performed comparing open versus endovascular repair. Multivariate analyses were conducted controlling for preoperative comorbidities including the presence of diabetes mellitus, cardiac, respiratory, and renal comorbidities as well as patient's age, gender, and ethnicity. The primary end point was mortality. Secondary end points were postoperative neurologic, cardiac, and respiratory complications.
  
  
  RESULTS
  There were 8967 patients who met the inclusion criteria. Of these patients, 8255 (92%) had an open repair and 712 (8%) had an endovascular repair. The overall mortality was 4.5% (4.6% for open and 3.6% for endovascular). On multivariate analysis, the odds of death were reduced by 46% among patients undergoing endovascular repair when compared to open repair (odds ratio [OR]: 0.54; P = .016). There was also reduced odds of a postoperative neurologic complication (OR: 0.48; P = .015), cardiac complication (OR: 0.24; P < .001), and respiratory complication (OR: 0.38: P = .001) in the endovascular group.
  
  
  CONCLUSIONS
  Nationwide data comparing open and TEVAR in the United States reveal decreased postoperative mortality and a decreased incidence of postoperative neurologic, cardiac, and respiratory complications for TEVAR.
authors.affiliation: Department of Surgery, Howard University College of Medicine, Washington, DC, USA kakra.hughes@howard.edu.
authors.forename: Kakra
authors.initials: K
authors.lastname: Hughes
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, VA, USA.
authors.forename: Jean
authors.initials: J
authors.lastname: Guerrier
authors.affiliation: Department of Surgery, Howard University College of Medicine, Washington, DC, USA.
authors.forename: Augustine
authors.initials: A
authors.lastname: Obirieze
authors.affiliation: Department of Anesthesiology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: Dora
authors.initials: D
authors.lastname: Ngwang
authors.affiliation: Department of Surgery, Howard University College of Medicine, Washington, DC, USA.
authors.forename: David
authors.initials: D
authors.lastname: Rose
authors.affiliation: Department of Surgery, Howard University College of Medicine, Washington, DC, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Tran
authors.affiliation: Department of Surgery, Howard University College of Medicine, Washington, DC, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Cornwell
authors.affiliation: Department of Medicine, Howard University College of Medicine, Washington, DC, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Obisesan
authors.affiliation: Division of Cardiothoracic Surgery, Baylor College of Medicine, Texas Heart Institute, Houston, TX, USA.
authors.forename: Ourania
authors.initials: O
authors.lastname: Preventza
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
keywords: endovascular repair of thoracic aortic aneurysms; open repair of thoracic aortic aneurysms; thoracic aortic aneurysms