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Blunt Thoracic Aortic Injury Manangment in a National Inpatient Sample.
Munier M. Nazzal, MD, George J. Philip, MD, weikai qu, MD, PhD, Hammad Amer, MD, Brett Aplin, MD, Brett Aplin, MD, Jihad Abbas, MD. University of Toledo, School of Medicine, Toledo, OH, USA.
BLUNT THORACIC AORTIC INJURY MANAGEMENT IN A NATIONAL INPATIENT SAMPLE Abstract Objective: To determine the hospital outcomes of endovascular (TEVAR) and open (OPEN) interventions of thoracic aorta injuries (TAI) by analyzing the data of patients with TAI in Nationwide Inpatient Sample (NIS) database. Methods: An analysis of approximately 2988 hospital admissions from 2008-2010 was obtained from the NIS database. NIS database is part of the Healthcare Cost and Utilization Project (HCUP) sponsored by the Agency for Healthcare Research and Quality (AHRQ). In this study we compare the 2 different treatment modalities for blunt thoracic aortic injury and compared length of stay, cost, postoperative mortality and morbidity rates. We used the ICD-9 coding system to extract information of the demographics, comorbidities, surgical interventions and early outcomes of the treatment for TAI patients from the NIS database (2008 -2010). The data was analyzed with SPSS Statistics v19. P<0.05 was considered statistically significant. Results: Total number of patients with TAI was 3615 (2526 males) in 3 years. Average age of the patients was 43.419.7 years. Of the individuals who suffered blunt aortic injury 1746(58.4%) cases were treated by surgical intervention. In cases that were managed surgically, TEVAR was used in 1453(83%) opposed to OPEN in 288(8.1%). There was a steady increase in proportion of TAI repair done by ENDO over the three-year period (78.6/21.4, 82.2/17.8 and 87.7/12.3 from 2008- 2010 respectfully). Chest wall fracture was present in 51.5% , 16.4% had internal injuries of thorax/abdomen/pelvis and 3.5% had head injuries. Hypertension and Diabetes were found in 20.1% and 5.6% of the patients, respectively. As indicated in table 1, mortality, ARF, cardiac complications, postoperative hemorrhage, pulmonary insufficiency and paraplegia rates were higher in open surgery. | | | | | | All surgery | Endovascular | Open | P | Mean Age (meanSD) | 41.718.3 | 42.418.4 | 38.017.5 | 0.000 | LOS (days, meanSD) | 19.520.6 | 19.721.2 | 18.617.2 | 0.310 | Total Charge (1,000 US$, MeanSD) | 294.9255.2 | 300.3266.2 | 267.6188.7 | 0.014 | Postoperative hemorrhage(%) | 3.9 | 0.7 | 3.2 | 0.016 | Mortality rate (n/%) | 140/8.1 | 111/7.7 | 29/10.1 | 0.177 | Paraplegia (%) | 0.5 | 0.3 | 1.4 | 0.047 | Postoperative Stroke (%) | 1.2 | 1.1 | 1.7 | 0.374 | Myocardial Infarction (%) | 1.2 | 1.0 | 1.7 | 0.358 | Renal Failure (%) | 0.2 | 0 | 1.4 | 0.001 | Pulmonary Insufficiency (%) | 31.7 | 29.8 | 41.7 | 0.000 | Cardiac complications (%) | 1.7 | 1.0 | 4.9 | 0.000 | Postoperative Infection (%) | 1.7 | 1.7 | 1.7 | 0.997 |
Conclusions: Majority of the TAI patients in USA who underwent surgical intervention were treated endovascularly in recent years. The data supports endovascular repair may reduce mortality and complications rates but is found to be more expensive.
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