Thirty-Day Endovascular Repair Outcomes of Stanford Type B Aortic Dissection in Patients With Diabetes Mellitus: A Propensity-Score-Matched Study From the ACS-NSQIP Database.

Abstract

Background: The surgical intervention for Stanford type B aortic dissection (TBAD) has been revolutionized by thoracic endovascular aortic repair (TEVAR). While diabetes mellitus (DM) is associated with increased risks of short-term mortality and infectious complications after major surgeries, previous studies present conflicting findings regarding the outcomes of TEVAR in DM patients. This study aimed to assess the 30-day postoperative outcomes for DM patients who have undergone TEVAR for TBAD using a dataset from a multi-institutional national registry.

Methods: Patients who underwent TEVAR for TBAD were selected from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2022. A 1:4 propensity-score matching was used to balance demographics and preoperative characteristics between patients with and without DM. Thirty-day postoperative outcomes were compared.

Results: There were 160 (8.89%) DM and 1640 (91.11%) non-DM patients who underwent TEVAR for TBAD. After propensity-score matching, all DM patients were matched to 594 non-DM patients. DM patients had a higher rate of mortality that was trending toward significance (10.19% vs 5.89%, p = 0.07). All 30-day complications were comparable between DM and non-DM patients.

Conclusion: TEVAR can generally be safe for DM patients in terms of short-term outcomes, but the potential for higher perioperative mortality rates in these patients may warrant careful consideration. Further large-scale studies may be necessary to fully understand the impact of DM on both short-term and long-term outcomes following TEVAR for TBAD.Clinical ImpactThis study assessed the 30-day postoperative outcomes for diabetes mellitus (DM) patients who have undergone thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection (TBAD) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. After propensity-score matching, DM patients had a higher rate of mortality that was trending toward significance but all 30-day complications were comparable between DM and non-DM patients. Therefore, TEVAR can generally be safe for DM patients in terms of short-term outcomes, but the potential for higher perioperative mortality rates in these patients may warrant careful consideration. Further large-scale studies may be necessary to fully understand the impact of DM on both short-term and long-term outcomes following TEVAR for TBAD.