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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.