TY - JOUR
T1 - Have thoracic endografting outcomes improved since US Food and Drug Administration approval?
AU - Bhamidipati, Castigliano M.
AU - Lapar, Damien J.
AU - Mehta, Gaurav S.
AU - Kern, John A.
AU - Kron, Irving L.
AU - Upchurch, Gilbert R.
AU - Ailawadi, Gorav
N1 - Funding Information:
This study was supported by grant T32/ HL007849 from the National Heart, Lung, and Blood Institute to Castigliano M. Bhamidipati, DO, and Damien J. LaPar, MD. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or the National Institutes of Health. This study was also supported by the Thoracic Surgery Foundation for Research and Education Research Grant to Gorav Ailawadi, MD.
Funding Information:
Data were abstracted from the Nationwide Inpatient Sample (NIS) between 2005 and 2007. The NIS is the largest HCUP (Healthcare Cost and Utilization Project) all-payer inpatient database, sponsored by the AHRQ (Agency for Healthcare Research and Quality). The NIS contains data from more than 8 million hospital discharges annually from 1,056 hospitals located in 42 states, representing 90% of all US nonfederal hospital discharges ( http://www.hcup-us.ahrq.gov/nisoverview.jsp ) [ 13 ]. The AHRQ has developed appropriately scaled discharge weights to generate national estimates of hospitalizations from the NIS ( http://www.hcup-us.ahrq.gov/db/nation/nis/nisdbdocumentation.jsp ). These weights help compare hospitalization rates across years despite the varying number of states participating each year. The HCUP validates the NIS for biases by comparing it to other population-based datasets ( http://www.hcup-us.ahrq.gov/reports/methods.jsp ).
PY - 2011/5
Y1 - 2011/5
N2 - Background: Thoracic endovascular aneurysm repair (TEVAR) is gaining acceptance since Food and Drug Administration approval in 2005. We hypothesize that, compared with open repair (OPEN), mortality and complication rate after TEVAR have continued to improve. Methods: All patients who underwent thoracic and (or) thoracoabdominal aneurysm repair from 2005 to 2007 in the Nationwide Inpatient Sample were examined. Patients were stratified by TEVAR or OPEN. Demographics, hospital characteristics, and outcomes were analyzed. Multivariable logistic regression models for complications and in-hospital mortality were developed. Results: A weighted total of 7,644 had TEVAR, while 32,948 patients underwent OPEN. The TEVAR utilization increased from 5.5% (2005) to 24.1% (2007). Mortality for all patients undergoing thoracic aneurysm repair decreased yearly (p <0.001). Mortality (TEVAR: 7.3%, OPEN: 9.8%, p <0.001) and complication rate (TEVAR: 24.3%, OPEN: 42.1%, p <0.001) were superior with TEVAR. The unadjusted annual mortality (7%) and complication rate (24%) after TEVAR did not improve each year; however, after risk adjustment, mortality after TEVAR steadily decreased annually. Moreover, risk-adjusted mortality for OPEN has improved since 2005. Multivariate analysis revealed age and ruptured aneurysm were highly predictive of death (p <0.001, respectively), while TEVAR lowered the adjusted odds of death by 18% (p <0.05). Conclusions: Mortality in patients undergoing repair of thoracic aneurysms has decreased in the United States since Food and Drug Administration approval of stent grafts in 2005. This is due to wider adoption of TEVAR and improved mortality in patients undergoing TEVAR or open repair.
AB - Background: Thoracic endovascular aneurysm repair (TEVAR) is gaining acceptance since Food and Drug Administration approval in 2005. We hypothesize that, compared with open repair (OPEN), mortality and complication rate after TEVAR have continued to improve. Methods: All patients who underwent thoracic and (or) thoracoabdominal aneurysm repair from 2005 to 2007 in the Nationwide Inpatient Sample were examined. Patients were stratified by TEVAR or OPEN. Demographics, hospital characteristics, and outcomes were analyzed. Multivariable logistic regression models for complications and in-hospital mortality were developed. Results: A weighted total of 7,644 had TEVAR, while 32,948 patients underwent OPEN. The TEVAR utilization increased from 5.5% (2005) to 24.1% (2007). Mortality for all patients undergoing thoracic aneurysm repair decreased yearly (p <0.001). Mortality (TEVAR: 7.3%, OPEN: 9.8%, p <0.001) and complication rate (TEVAR: 24.3%, OPEN: 42.1%, p <0.001) were superior with TEVAR. The unadjusted annual mortality (7%) and complication rate (24%) after TEVAR did not improve each year; however, after risk adjustment, mortality after TEVAR steadily decreased annually. Moreover, risk-adjusted mortality for OPEN has improved since 2005. Multivariate analysis revealed age and ruptured aneurysm were highly predictive of death (p <0.001, respectively), while TEVAR lowered the adjusted odds of death by 18% (p <0.05). Conclusions: Mortality in patients undergoing repair of thoracic aneurysms has decreased in the United States since Food and Drug Administration approval of stent grafts in 2005. This is due to wider adoption of TEVAR and improved mortality in patients undergoing TEVAR or open repair.
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U2 - 10.1016/j.athoracsur.2011.01.037
DO - 10.1016/j.athoracsur.2011.01.037
M3 - Article
C2 - 21439547
AN - SCOPUS:79955371764
SN - 0003-4975
VL - 91
SP - 1314
EP - 1322
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 5
ER -