Readmissions after Thoracic Endovascular Aorta Repair
Bindu Kalesan, Ph.D., M.P.H., Thomas W. Cheng, M.S., Nikita Fnu, Jeffrey A. Kalish, M.D., Kimberly Lu, Michaella V. Latkovic-Taber, M.P.H., Alik Farber, M.D., Jeffrey J. Siracuse, M.D..
Boston University, Boston, MA, USA.
OBJECTIVE: Patients undergoing Thoracic Endovascular Aortic Repair (TEVAR) often have many comorbidities and their care can be resource intensive. One way to gauge resource utilization is readmission rate. Our objective was to analyze reasons for TEVAR readmissions within 30, 90, and 180 days.
METHODS: A retrospective analysis was performed of the Nationwide Readmissions Database (NRD) for all patients who underwent TEVAR for descending thoracic aorta dissection and aneurysm in 2013. Patients with ascending aneurysm pathology and concomitant open repair were excluded. Multivariable analysis was performed to identify predictors for readmissions at 30, 90, and 180 days.
RESULTS: There were 3,789 patients who underwent TEVAR were identified. Mean patient age was 67.7 years and 60.8% were male. Proximal debranching was done in 14.2% and iliac access was in 1.3%. Mean Elixhauser co-morbidity score was 4.29. Perioperative mortality rate was 2.9%. There were 1,219 (32.2%) readmissions overall with 419 (11.1%) readmissions within 30 days, 895 (23.6%) readmissions within 90 days, and 1,131 (29.8%) within 180 days. The most common reasons for index readmission within 30 days were non-aortic infections (14%), aorta related complications (11.3%), and cardiac complications (11.3%). The most common reasons for index readmission within 90 days were aorta related complications (17.1%), non-aortic infections (15.0%), and cardiac complications (11.3%). Within 180 days, the most common reasons were aorta related (18.0%), non-aortic infections (15.7%), and gastrointestinal complications (10.6%). During a readmission, 145 (3.8%) patients underwent a reoperation which consisted of 100 additional thoracic stents and 66 open repairs. Half of readmissions occurred less than 2 months postoperatively. On multivariable analysis independent predictors of readmission included age >60 (OR: 1.52, 95% CI: 1.09-1.12, P=.014), higher Elixhauser comorbidity score (OR: 1.17, 95% CI: 1.09-1.26, P<0.0001), non-elective procedures (OR: 1.59, 95% CI: 1.23-2.04, P<.0001), and index procedure at a hospital in the same state as residence (OR: 2.60, 95% CI: 1.64-4.10, P<.0001). Hospital factors, including teaching status and location, and economic factors, including insurance and income, were not predictive of readmission.
CONCLUSION: Patients with more a high rate of comorbidities and advanced age were at higher risk for readmission after undergoing TEVAR. Almost one third of the patient were readmitted with 180 days. The majority patients were readmitted for non-aortic indications and the overall rate of reoperation was low.
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