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Trends in Aortic Repair at a Tertiary Academic Center 2007-2014
mathew wooster, MD, Adam Tanious, MD, Alexis Powell, MD, Paul Armstrong, DO, Martin Back, MD, Karl Illig, MD, Brad Johnson, MD, Murray Shames, MD.
University of South Florida, tampa, FL, USA.
Objective: Concern has arisen regarding the ability to train future surgeons in open aortic exposure as endovascular repair has blossomed. Recognizing these concerns and the current literature suggesting trainee experience has decreased, we sought to review the trends in open versus endovascular aortic repair in a tertiary referral center responsible for training nine vascular and general surgery graduates annually.
Methods: Deidentified billing records were reviewed by CPT and ICD-9 codes to identify all patients treated for thoracic or abdominal aortic pathology from 2007 (first year of the integrated vascular surgery residency) to 2014. Data from the current year was excluded from all comparisons involving gross volume per year given that it is incomplete, but was included in comparisons involving relative proportions.
Results: Over the 7-year period studied, total aortic repairs fluctuated with a nadir of 96 in 2010 and peak 141 in 2013. Thoracic, abdominal, and total aortic repairs all decreased from 2007 to 2010, then increased to a peak in 2013. There was a concomitant increase in proportion of open repairs as the total number decreased, followed by a decrease in proportion of open repairs as the total number increased (Figure). Open repair accounted for 15-40% of procedures annually and ruptured aneurysms accounted for 3-14 cases annually. The primary insurance provider was Medicare for 60-75% of patients through the study period.
Conclusions: Total case volume has increased, and despite the growth of endovascular repair, there remains a stable volume of open aortic experience. The trends in volume and proportion of endovascular versus open repairs as well as thoracic versus abdominal repairs suggest an increased complexity of cases. A possible reason for the increase in volume may be attributed to an increase in salvage procedures for failing endografts and the introduction endovascular procedures for juxtarenal and suprarenal AAA’s. Future work is needed to compare the relative complexity and indications for repairs, but overall, there appears to be a stable operative experience offered to graduating surgeons at our institution.
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