Age And Sex-specific Outcomes After Blunt Thoracic Aortic Injury
Donald T. Baril, M.D.1, Akbarshakh Akhmerov, MD1, Joseph J. Dubose, MD2, Naveed Saqib, MD3, Benjamin W. Starnes, MD4, Elina W. Quiroga, MD4, Charles C. Miller, PhD3, Ali Azizzadeh, MD1.
1Cedars-Sinai Medical Center, Los Angeles, CA, USA, 2Dell Medical School at the University of Texas at Austin, Austin, CA, USA, 3University of Texas Health Science Center at Houston, Houston, CA, USA, 4University of Washington, Seattle, CA, USA.
Objective: Despite advances in technology and the increased use of endovascular management, blunt thoracic aortic injury (BTAI) continues to be associated with high rates of morbidity and mortality. The objective of this study was to evaluate patients with BTAI and determine if there are differences in outcomes based on age or sex. Methods: A retrospective analysis of prospectively collected data from the Aortic Trauma Foundation registry was used to evaluate demographics, injury details, management, and outcomes of patients with BTAI. Outcomes were stratified by three distinct age-groups and by sex. Multivariable logistic regression was used to identify predictors of mortality. Results: A total of 539 patients with BTAI (age 43.7 ± 17.9, male 76.3%) were stratified by age: <40 years, 40-65 years, >65 years. A significantly higher proportion of patients in the oldest cohort (>65) had cardiovascular comorbidities compared with the younger cohorts, while there were no differences in baseline characteristics based on sex. A higher proportion of patients >65 years had Grade IV aortic injuries compared with patients <40 and 40-65 years (15.9%, 7.8%, and 8.5%, respectively; P<0.001). No significant differences in BTAI severity were noted between sexes (p=0.129). Medical management and TEVAR were the predominant treatment modalities (n=162, 30.1% and n=337, 62.5%, respectively), with no differences in the proportion of patients receiving either treatment based on age or sex. The overall in-hospital mortality was 11.1% (n=60), and patients >65 years had significantly higher mortality (21.7%; adjusted OR 3.3; 95% CI 1.2-9.2; P=0.025) compared with patients 40-65 years and <40 years (13.7% and 6.2%, respectively). There were no differences in survival based on sex. Conclusions: After adjustment for comorbidities, injury mechanism and severity, and BTAI treatment, advanced age, but not sex, is associated with significantly higher mortality after BTAI. Targeted management strategies in this frail population may improve outcomes after BTAI.
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