Trends in utilization, timing, and outcomes of thoracic endovascular repair for type B aortic dissection in the United States

Abstract

Background

Aortic dissection is the most common acute aortic syndrome in the United States. Type B aortic dissection (TBAD) can be managed medically, through open surgical repair, or with thoracic endovascular repair (TEVAR). The present study sought to assess contemporary trends in the use and timing of TEVAR.

Methods

Adult nonelective TBAD admissions were identified in the 2010 to 2020 Nationwide Readmissions Database. Patients were categorized as medical management (Medical Management), TEVAR at initial hospitalization (Early), or TEVAR during readmission (Delayed). Multivariable models were developed to assess associations with clinical outcomes and resource utilization.

Results

Of 85,753 patients, 8.7% underwent TEVAR at index hospitalization (Early). From 2010 to 2020, the proportion undergoing TEVAR decreased significantly (from 11.3% to 9.6%; nptrend < .001), while the proportion of TEVAR at a subsequent hospitalization increased (from 13.0% to 21.6%; nptrend < .001). Compared to Medical Management, the Early group was younger (median. 63 [interquartile range (IQR), 52-74] years vs 69 [IQR, 57-81] years), and more frequently privately insured (27.7% vs 17.5%; P < .001). Following adjustment, the Early group had a reduced odds of mortality (adjusted odds ratio [aOR], 0.56; 95% confidence interval [CI], 0.48-0.66) and increased hospitalization costs (β = +$50,000; 95% CI, $48,000-$53,000). Among 4267 TEVAR patients with available procedure timing data, 15.7% were categorized as Delayed. The Early and Delayed groups did not differ in terms of demographics. The Delayed group had a decreased likelihood of major adverse events (aOR, 0.50; 95% CI, 0.39-0.64); however, this did not affect 90-day cumulative hospitalization costs (β = +$2700; 95% CI, -$5000-$11,000, ref: Early).

Conclusions

This study suggests changes to TBAD management in both treatment modality and TEVAR timing. Focused analysis on the timing and long-term costs of TEVAR are needed to optimize care delivery.