Trends in Aortic Dissection Hospitalizations, Interventions, and Outcomes Among Medicare Beneficiaries in the United States, 2000–2011

Abstract

Background The epidemiology of aortic dissection (AD) has not been well-described among older persons in the United States. It is not known whether advancements in AD care over the last decade have been accompanied by changes in outcomes. Methods and Results The Inpatient Medicare data from 2000 to 2011 were used to determine trends in hospitalization rates for AD. Mortality rates were ascertained through corresponding vital status files. A total of 32,057 initial AD hospitalizations were identified between 2000 and 2011. The overall hospitalization rate for AD remained unchanged at 10 per 100,000 person-years. For 30-day and 1-year mortality associated with AD, the observed rate decreased from 31.8% to 25.4% (difference, 6.4%; 95% confidence interval [CI], 6.2–6.5; adjusted, 6.4%; 95% CI, 5.7–6.9) and from 42.6% to 37.4% (difference, 5.2%; 95% CI, 5.1–5.2; adjusted, 6.2%; 95% CI, 5.3–6.7) respectively. For patients undergoing surgical repair for type A dissections, the observed 30-day mortality decreased from 30.7% to 21.4% (difference, 9.3%; 95% CI, 8.3–10.2; adjusted, 7.3%; 95% CI, 5.8–7.8) and the observed 1-year mortality decreased from 39.9% to 31.6% (difference, 8.3%; 95% CI, 7.5–9.1%; adjusted, 8.2%; 95% CI, 6.7 – 9.1). The 30-day mortality decreased from 24.9% to 21% (difference, 3.9%; 95% CI, 3.5–4.2; adjusted, 2.9%; 95% CI, 0.7–4.4) and 1-year decreased from 36.4% to 32.5% (difference, 3.9%; 95% CI, 3.3–4.3; adjusted, 3.9%; 95% CI, 2.5–6.3) for surgical repair of type B dissection. Conclusions While AD hospitalization rates remained stable, improvement in mortality was noted, particularly in patients undergoing surgical repair.

Non-White Race Is an Independent Risk Factor for Hospitalization for Aortic Dissection

“…[13][14][15][16]22 For example, the Oxford Vascular Study reported AD incidence of 6/100,000, but studied a population that was 94% White that may not be representative outside of Western Europe. 22 The AD hospitalization rate in this study of 9/100,000 was similar to the 10/100,000 in a recent study of the United States National Inpatient Sample (NIS) by Mody et al, 23 but by accounting for state and county population data, our analysis gives new insight into the relationships between demographics and disparities as they relate to AD.…”

“…This regional phenomenon likely reflects a national disparity, as the different racial admission rates are similar to an NIS study that estimated nationwide AD admission rates for Whites and Blacks of 9 and 14/100,000, respectively. 23 Non-White patients in our study presented differently: they were more often female and were younger, despite similar or lower rates of most comorbidities. Further, the associations between lower income, greater income inequality, and AD admissions suggest an important socioeconomic component for AD risk and development.…”

Influence of distal entry tears in acute type B aortic dissection after thoracic endovascular aortic repair

“…5,24 Thanks to this revolutionary technology, perioperative morbidity and mortality were greatly improved. However, long-term outcomes with type B aortic dissection were still suboptimal, as previous studies showed.…”

“…3,4 Thus, treatment of ATBAD has gradually evolved into endovascular therapy. 5 The aim of the standard TEVAR procedure includes mending the primary entry tear, relieving the compression of the true lumen and malperfusion, obliterating the false lumen, and reducing the aortic dissection-related complications and mortality. 6 However, patients with ATBAD usually have multiple entry tears, whereas TEVAR procedures only resolve primary entry tears, and distal entry tears are routinely left behind.…”

Operative Strategies and Outcomes in Type a Aortic Dissection after the Enactment of a Multidisciplinary Aortic Surgery Team

“…23 Through observations of Medicare data, it has been demonstrated that 30-day mortality has been reduced across the United States as well as at individual centers even in the absence of aortic surgery programs. 7,24 Third, it is possible that concurrent institutional performance improvement programs influenced these results, such as new guidelines for ventilator management and blood conservation. Nevertheless, our results and the growing literature supporting the benefits of an aortic surgery team highlight strategies for outcomes improvement in this highly lethal syndrome.…”