Perioperative Outcomes After Open and Endovascular Repair of Intact Thoracic Aortic Aneurysms: Results of the Nationwide Inpatient Sample

OBJECTIVES:
Since the introduction of the endovascular approach to thoracic aortic aneurysm (TAA) repair, the optimal treatment has been controversial. Initial studies comparing the endovascular with the open approach have been limited by small sample sizes, bias from institutional learning curves, heterogeneous patient populations, and incomplete outcome data. Late 2005 was the first time that an ICD-9 procedure code was available specifically for endovascular TAA repair. We compared the perioperative outcome of open surgical and endovascular intact TAA repair over the last three months of 2005 using a national administrative database. To our knowledge, this is the first use of a nation-wide database to compare open and endovascular TAA repair outcomes.

METHODS:
The Nationwide Inpatient Sample was used to identify patients undergoing open or endovascular TAA repair in October through December, 2005. Patient demographic data, length of stay, hospital charges, patient disposition, and mortality were examined.
RESULTS: 257 patients underwent open TAA repair and 242 underwent endovascular repair. There was no significant difference in mortality between open and endovascular repair (adjusted OR, .756; 95% CI, .367-1.56). Endovascular patients were more likely to be discharged to home (adjusted OR, 5.62; 95% CI, 3.62-8.74). Patients treated via an endovascular approach had a decreased length of stay--4.85 days versus 12.30 days (p=.002). The difference in hospital charges was not significant (p=.066).

CONCLUSIONS:
While further study is warranted, this first study of a nation-wide sample suggests that endovascular TAA repair is safe in the short-term and requires a shorter hospital stay than open repair.