KAREN L. WALKER MS JONATHAN J. SHUSTER PHD THOMAS M. BEAVER MD, MPH DIVISION OF THORACIC AND CARDIOVASCULAR SURGERY DIVISION OF BIOSTATISTICS UNIVERSITY.

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KAREN L. WALKER MS JONATHAN J. SHUSTER PHD THOMAS M. BEAVER MD, MPH DIVISION OF THORACIC AND CARDIOVASCULAR SURGERY DIVISION OF BIOSTATISTICS UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE GAINESVILLE, FLORIDA US Trends in Thoracic Aneurysm Repair

Objective National practice patterns for thoracic aneurysm repair are largely unknown because the US does not have a thoracic aneurysm endovascular repair registry. The National Inpatient Sample was employed to determine the effects of the 2005 FDA approval of thoracic aneurysm endografts on the surgical management of patients with thoracic aneurysms.

National Inpatient Sample (NIS) 20% stratified sample of US hospital discharges 8 million hospital discharges Can be weighted to generate national estimates Can be used to assess in-hospital complications, mortality and outcomes. Cannot be used to assess long-term outcomes.

Methods Population  ICD-9 codes were used to identify all thoracic aneurysm cases with endovascular repair (39.73) or Open Repair (38.45) procedure code.  Exclusion criteria were applied enabling the selection of only unruptured descending thoracic aortic aneurysm repairs. NIS was used to generate repair rates which were adjusted for annual population estimates. Meta-analysis controlling for center was performed to compare differences in age, comorbidities, complications, and LOS for Open repair vs. TEVAR (Thoracic EndoVascular Aortic Repair).

Results: An increase in diagnosis of Thoracic aneurysms followed introduction of 16 slice CT scanners in 2003 An increased overall repair rate of thoracic aneurysms followed 2005 FDA approval of thoracic endografts (TEVAR). Increased adoption of Thoracic endograft repair may follow previous trends in Abdominal endograft repair (EVAR). TEVAR (Thoracic EndoVascular Aortic Repair) patients were older with more comorbidities, but had shorter LOS, fewer complications and decreased mortality.

Thoracic CT Scan Utilization and Diagnosis of Unruptured Thoracic Aneurysm

Trends in Unruptured Descending Thoracic Aneurysm Repair

Trends in Abdominal Aneurysm Repair

Comorbidities in 2006 Cohort: Only Those Institutions in 2006 NIS Cohort Performing Both TEVAR and Open Repair Open RepairTEVARRelative RiskP-Value Current or Previous Smoker12.63 %36.37 % Chronic Kidney Disease2.03%12.05% Diabetes5.69 %16.85 % Hypertension76.18 %78.63 % Coronary Artery Disease21.15 %25.06 % Previous Myocardial Infarction 3.65 %6.09 % Congestive Heart Failure10.40 %9.01 % COPD27.47 %32.27 % Peripheral Vascular Disease0 %5.07 %0.

Complications in 2006 Cohort : Only Those Institutions in 2006 NIS Cohort Performing Both TEVAR and Open Repair Open RepairTEVARRelative RiskP-Value Cardiac Complication7.13 %1.21 % Respiratory Complication23.37 %8.28 % Ventilation > 96 hrs13.41 %1.97 % Transfusion32.52 %15.77 % Hemorrhage7.13 %3.45 % Acute Renal Failure8.35 %3.51 % Postoperative Stroke/TIA3.65 %2.65 % Paraplegia0.40 %0.73 % Peripheral Vascular Complication2.43 %4.60 % Graft Problem2.84 %4.75 %0.59

Mean Age and Length of Stay: Only Those Institutions in 2006 NIS Cohort Performing Both TEVAR and Open Repair Open RepairTEVARP-value Age <.01 LOS96<.01 Mortality9.79%1.15%<.01 OLDER Decreased LOS Decreased mortality TEVAR Patients

Conclusions TEVAR has been rapidly adopted in the US resulting in increased treatment of thoracic aortic aneurysms. Trends in abdominal aneurysm repair may foreshadow future trends in thoracic aneurysm repair. Despite older age and comorbidities, TEVAR had better outcomes and shorter hospital stays. Vigilant surveillance of TEVAR patients is warranted because the long-term outcomes are unknown.