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.

An outcome analysis of endovascular versus open repair of blunt traumatic aortic injuries

“…Consistent findings have been reported in the literature. [7][8][9][14][15][16] It is important to note that the overall injury pattern has a significant effect in the primary outcomes, death, and complications and that OR vs TEVAR repair is only one component of the global treatment plan. Our cost analysis showed a higher adjusted mean variable costs for TEVAR than for OR (P ϭ .017).…”

“…15 The only published study in the United States analyzed the 2005-2006 Nationwide Inpatient Sample and found significantly higher hospital costs for OR. 16 To our knowledge, the current study represents the only single-institution analysis of hospital cost for treatment of traumatic aortic injury in the United States. The findings do not reflect a significant difference in total hospital costs between OR and TEVAR.…”

Descending thoracic aortic surgery

“…In a related, recently published meta-analysis, Biancari et al [24] suggest that endovascular repair of isolated abdominal aortic aneurysms (AAA) is associated with a short-term mortality benefit compared to open repair (2.3 versus 8.6%) in patients older than 80 years, but this benefit is lost after 3 years follow-up [24]. Nevertheless, exactly how endovascular treatment will change the management of traumatic aortic injuries remains to be determined, yet studies have been published that evaluated selective nonoperative strategies [29][30][31] and whether endovascular strategies are cost-effective in this setting [32]. ], as has one other recent study [27].…”

Thoracic Endovascular Aortic Repair Versus Open Repair: Analysis of the National Trauma Data Bank

“…The increased complications in TEVAR versus open repair are associated with increased hospital costs. 5 The data supporting decreased ICU-LOS, complications, and mortality from TEVAR use have the potential to reduce hospital costs of patients with BTAI. Previous studies have found that increased hospital LOS and increased complications in TEVAR versus open repair are linked with increased hospital costs and that TEVAR has significantly lower costs compared to open repair at all time points up to 3 y after intervention.…”

“…Literature has shown that use of TEVAR is associated with fewer surgical complications versus open repair procedures. 5 Open repair of traumatic aortic injury was found to have a complication rate of 17.0% with complications most commonly arising due to injury of the recurrent laryngeal nerve, whereas endovascular repair was revealed to have a complication rate of 13.0% with predominant vascular access complications, such as iliac artery injury, including pseudoaneurysm and thrombosis. 4 Rising hospital costs associated with prolonged ICU-LOS and surgical complications is a current economic burden.…”