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Outcomes of Open Descending Thoracic Aortic Aneurysm Repair Using the Nationwide Inpatient Sample

Objective: To evaluate national outcomes after open repair of descending thoracic aortic aneurysm (DTA). Methods: DTA repairs were identified from the NIS database from 1988-2003 by ICD9 codes. In-hospital mortality and morbidity were noted. Demographics, rupture status, admission type (elective vs emergent), and annual hospital volume tercile (high (HVH), medium (MVH), and low (LVH)) were analyzed using multivariate regression to predict mortality. Results: 2549 DTA repairs were identified (1976 intact, 573 ruptured). Mortality was 10% for intact and 45% for ruptured DTA. Of intact repairs, mortality was 14% after emergent admission vs 9% after elective admission. Mortality after intact repair was lower at HVH (8%) than LVH (13%) or MVH (12%). Hospital volume tercile did not predict rupture mortality. Complications after intact DTA repair were coded in 42%; including respiratory (13%), cardiac (11%), acute renal failure (8%), stroke (3%), and neuro (non-stroke) (2%). Complications were coded in 49% after ruptured DTA repair; including respiratory (13%), cardiac (13%), acute renal failure (20%), stroke (3%), and neuro (non-stroke) (2%). Predictors of mortality (for all DTA repairs) were (OR, 95% CI): age 65-74 vs age<65 (2.0, 1.5-2.7), age ≥75 vs age <65 (2.9, 2.1-4.0), female gender (0.75, 0.60-0.95), rupture (4.6, 3.5-6.0), emergent admission (1.7, 1.3-2.3), and LVH or MVH vs HVH (1.3, 1.1-1.8). Conclusions: Mortality after open repair of DTA is high and complications are common. Mortality is dependent upon age, gender, rupture status, admission type, and hospital volume. Results of endovascular DTA repair should be compared using similar population based data.