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OBJECTIVES:
Management of acute Type B aortic dissection (ATBAD) remains a challenge. The purpose of this study was to determine the cost and outcomes of patients with ATBAD.
METHODS:
We analyzed prospectively collected data between 2001 and 2012. Data were supplemented with a retrospective review of hospital financial accounts. Patients were categorized as either uncomplicated (U) or complicated (C) ATBAD. Criteria for CATBAD were rupture, malperfusion, retrograde dissection, and neurological deficit. The primary outcomes were fixed, variable, and total hospital charges. The secondary outcomes were mortality, morbidity, and length of stay (LOS). Statistical analysis was performed using SAS 9.2 (SAS Institute, Cary, NC).
RESULTS:
We treated 470 patients with ATBAD during the study period. Hospital financial data was available on 104 consecutive patients (65 males; mean age 61.9 ± 13.9 years). Among them, 72 (69%) with UATBAD were managed medically, while 32 (31%) with CATBAD underwent thoracic endovascular repair (TEVAR, n=2), open repair (OR, n=23), or medical management (MM, n=7). The mean fixed, variable, and total hospital charges were significantly lower (p<.0001) in UATBAD ($7,598, $19,123, and $26,722) compared to CATBAD ($20,121, $57,950, and $78,071), respectively. The mortality (2.8% vs 25%; odds ratio 11.7, p<.003), morbidity (1.8% vs 16.6%; odds ratio 13.2, p<.03), and mean LOS (9.3 ± 5.2 days vs 18.9 ± 12.9 days, p<.0003) were significantly lower in UATBAD compared to CATBAD, respectively. On average, the total hospital charges for patients with CATBAD were $65,326 for TEVAR, $87,490 for OR, and $50,764 for MM. Total cost of MM for UATBAD (model intercept) was $26,722. Multiple linear regression analysis demonstrated that attributable cost increment estimates for additional intensity were $24,042 (p=0.06) for complicated presentation, $36,727 (p<0.01) for OR, and $14,526 (p=0.57) for TEVAR. Complications arising from ATBAD for all patients are ultimately statistically attributable to renal sequelae ($65,661; p<0.0001), neurological sequelae ($91,267; p<0.02) and extremity malperfusion ($36,169; p<0.03) rather than OSR ($18,551; p=0.11) or complicated initial presentation ($17,398; p=0.09).
CONCLUSIONS:
Patients with CATBAD have significantly higher hospital charges, mortality, morbidity, and LOS compared to those with UATBAD. This study serves as a baseline to compare cost and outcomes of modes of therapy for patients with ATBAD.