Hospital Incidence and In‐Hospital Mortality of Surgically and Interventionally Treated Aortic Dissections: Secondary Data Analysis of the Nationwide German Diagnosis‐Related Group Statistics From 2006 to 2014

Abstract

Background Population‐based data about the incidence and mortality of patients with aortic dissections ( ADs ) are sparse. Therefore, the hospital incidence and in‐hospital mortality of patients undergoing open or endovascular surgery for type A ADs ( TAADs ) and type B ADs ( TBADs ) in Germany were analyzed on a nationwide basis between 2006 and 2014. Methods and Results A secondary data analysis of the nationwide diagnosis‐related group statistics, compiled by the German Federal Statistical Office, was performed for patients who were surgically/interventionally treated for AD ( International Classification of Diseases, Tenth Revision, German Modification [ ICD ‐10‐ GM ] codes I71.00‐I71.07; n=20 533). By using specific procedure codes, a distinction between TAAD (n=14 911/72.6%) and TBAD (n=5622/27.4%) could be made. The standardized hospital incidence of surgically/interventionally treated AD was 2.7/100 000 per year, comprising 2.0/100 000 per year for TAAD and 0.7/100 000 per year for TBAD . The in‐hospital mortality of TAAD was 19.5%; and of TBAD, 9.3%. Both the incidence and in‐hospital mortality increased over the 9‐year period. The share of endovascularly treated TBAD increased steadily during the same time interval. A multilevel multivariable analysis revealed that, for TAAD , age and comorbidity were significantly associated with a higher mortality risk. The latter was also true for TBAD . Sex was not significantly associated with mortality. A significant association between higher annual center volume and mortality was found for TAAD , but not for TBAD . Conclusions This is the first report on hospital incidence and mortality for surgically/interventionally treated AD on a nationwide basis. Overall, in Germany, hospital incidence and mortality of TAAD and TBAD increased over time. In addition, TAAD is performed more safely in high‐volume centers.

Evaluating the diagnostic accuracy of maximal aortic diameter, length and volume for prediction of aortic dissection

“…Acute type A aortic dissection (ATAAD) is a medical emergency that carries high morbidity and mortality rates. Only half of patients survive until arrival at the hospital for emergency surgery, and another 20% of these die perioperatively due to severe disease complications (such as end-organ malperfusion) 1–3. To date, the maximal aortic diameter is the only recognised anatomic predictor for dissection and rupture.…”

Medikolegale Aspekte des präklinischen Managements von „akuten Aortensyndromen“

“…Die Inzidenz der Erkrankung liegt bei 11,9 Erkrankungen pro 100 000 Einwohner [1]. Bei der operativen Versorgung dieser Patienten zeichnet sich ein klarer Trend zur Versorgung in sogenannten "High Volume-Zentren" ab [2]. Der erste präklinische Kontakt ist in > 70 % der Fälle der Rettungsdienst [3,4].…”

Management of Aortic Root in Type A Dissection: Bentall Approach

“…Acute type A aortic dissection (ATAAD) is one of the most dramatic life-threatening diseases with an incidence that may be significantly higher than previously assumed based on previous retrospective studies [1][2][3][4][5]. This is underlined by the fact that up to one-half of ATAAD cases are detected only at autopsy [5].…”