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Romijn ASC, Proaño-Zamudio JA, Rastogi V, Yadavalli SD, Lagazzi E, Giannakopoulos GF, Schermerhorn ML, Saillant NN. Readmission after thoracic endovascular aortic repair following blunt thoracic aortic injury. Eur J Trauma Emerg Surg 2024; 50:551-559. [PMID: 38224357 DOI: 10.1007/s00068-023-02432-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE Thoracic endovascular aortic repair (TEVAR) is increasingly utilized to treat blunt thoracic aortic injury (BTAI), but post-discharge outcomes remain underexplored. We examined 90-day readmission in patients treated with TEVAR following BTAI. METHODS Adult patients discharged alive after TEVAR for BTAI in the Nationwide Readmissions Database between 2016 and 2019 were included. Outcomes examined were 90-day non-elective readmission, primary readmission reasons, and 90-day mortality. As a complementary analysis, 90-day outcomes following TEVAR for BTAI were compared with those following TEVAR for acute type B aortic dissection (TBAD). RESULTS We identified 2085 patients who underwent TEVAR for BTAI. The median age was 43 years (IQR, 29-58), 65% of all patients had an ISS ≥ 25, and 13% were readmitted within 90 days. The main primary causes for readmission were sepsis (8.8%), wound complications (6.7%), and neurological complications (6.5%). Two patients developed graft thrombosis as primary readmission reasons. Compared with acute TBAD patients, BTAI patients had a significantly lower rate of readmission within 90 days (BTAI vs. TBAD; 13% vs. 29%; p < .001). CONCLUSION We found a significant proportion of readmission in patients treated with TEVAR for BTAI. However, the 90-day readmission rate after TEVAR for BTAI was significantly lower compared with acute TBAD, and the common cause for readmission was not related to residual aortic disease or vascular devices. This represents an important distinction from other patient populations treated with TEVAR for acute vascular conditions. Elucidating differences between trauma-related TEVAR readmissions and non-traumatic indications better informs both the clinician and patients of expected post-discharge course. Level of evidence/study type: IV, Therapeutic/care management.
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Affiliation(s)
- Anne-Sophie C Romijn
- Division of Trauma & Emergency Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., White Building, Suite 506, Boston, MA, 02114, USA.
- Division of Trauma & Emergency Surgery, Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands.
| | - Jefferson A Proaño-Zamudio
- Division of Trauma & Emergency Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., White Building, Suite 506, Boston, MA, 02114, USA
| | - Vinamr Rastogi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Division of Vascular Surgery, Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Sai Divya Yadavalli
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Emanuele Lagazzi
- Division of Trauma & Emergency Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., White Building, Suite 506, Boston, MA, 02114, USA
| | - Georgios F Giannakopoulos
- Division of Trauma & Emergency Surgery, Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Noelle N Saillant
- Division of Acute Care and Trauma Surgery, Department of Surgery, Boston Medical Center, Boston, MA, USA
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Liu T, Devlin PJ, Whippo B, Vassallo P, Hoel A, Pham DT, Johnston DR, Chris Malaisrie S, Mehta CK. Neighborhood Socioeconomic Status and Readmission in Acute Type A Aortic Dissection Repair. J Surg Res 2024; 296:772-780. [PMID: 38382156 DOI: 10.1016/j.jss.2023.12.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 12/08/2023] [Accepted: 12/29/2023] [Indexed: 02/23/2024]
Abstract
INTRODUCTION We examined the association of socioeconomic status as defined by median household income quartile (MHIQ) with mortality and readmission patterns following open repair of acute type A aortic dissection (ATAAD) in a nationally representative registry. METHODS Adults who underwent open repair of ATAAD were selected using the US Nationwide Readmissions Database and stratified by MHIQ. Patients were selected based on diagnostic and procedural codes. The primary endpoint was 30-d readmission. RESULTS Between 2016 and 2019, 10,288 individuals (65% male) underwent open repair for ATAAD. Individuals in the lowest income quartile were younger (median: 60 versus 64, P < 0.05) but had greater Elixhauser comorbidity burden (5.9 versus 5.7, P < 0.05). Across all groups, in-hospital mortality was approximately 15% (P = 0.35). On multivariable analysis adjusting for baseline comorbidity burden, low socioeconomic status was associated with increased readmission at 90 d, but not at 30 d. Concomitant renal disease (odds ratio [OR], 1.68; P < 0.001), pulmonary disease (OR, 1.26; P < 0.001), liver failure (OR 1.2, P = 0.04), and heart failure (OR, 1.17; P < 0.001) were all associated with readmission at 90 d. The primary indication for readmission was most commonly cardiac (33%), infectious (16.5%), and respiratory (9%). CONCLUSIONS In patients who undergo surgery for ATAAD, lower MHIQ was associated with higher odds of readmission following open repair. While early readmission for individuals living in the lowest income communities is likely attributable to greater baseline comorbidity burden, we observed that 90-d readmission rates are associated with lower MHIQ regardless of comorbidity burden. Further investigation is required to determine which patient-level and system-level interventions are needed to reduce readmissions in the immediate postoperative period for resource poor areas.
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Affiliation(s)
- Tom Liu
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Paul J Devlin
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Beth Whippo
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Patricia Vassallo
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrew Hoel
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Duc Thinh Pham
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Douglas R Johnston
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sukit Chris Malaisrie
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Christopher K Mehta
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Lejot A, Ledieu G, Lenne X, Bruandet A, Delsart P, Girard A, Patterson B, Sobocinski J. Aortic dissection: results of the invasive treatment in France between 2012 and 2018 according to the French national database. THE JOURNAL OF CARDIOVASCULAR SURGERY 2023; 64:526-533. [PMID: 37382212 DOI: 10.23736/s0021-9509.23.12570-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
BACKGROUND To evaluate results of the invasive repair in the management of acute aortic dissection (AoD) in France. METHODS Patients admitted to hospital with acute AoD from 2012 to 2018 were identified. Patient demographics, severity score at admission, treatment strategy and in-hospital mortality were described. For patients undergoing intervention, perioperative complications rate was reported. A secondary analysis evaluating patients' outcome as regards of the annual caseload per center was conducted. RESULTS Overall, 14,706 patients with acute AoD were identified (male 64%, mean age 67, median modified Elixhauser score 5). The overall incidence increased during the study period (from 3.8 in 2012 to 4.4/100,000 in 2018) associated with a North-South gradient (respectively 3.6 vs. 4.7/100,000) and a winter peak; 45.5% (N.=6697) of patients received medical treatment alone. Among those with invasive repair, 6276 (78.3%) were defined as type A AoD (TAAD), whereas type B AoD (TBAD) accounted for 1733 patients (21.7%), of whom 1632 (94%) had TEVAR and 101 (6%) had other arterial procedures; 30-day mortality was respectively 18.9% in TAAD and 9.5% for TBAD. In high-volume centers (i.e. >20 AoD/year), a lower 3-month mortality of 22.3% was noted compared to 31.4% in the low-volume centres (P<0.001); 47% of patients reported ≥1 early major complication. TEVAR exhibited less complication (P<0.001) compared to other arterial reconstructions in TBAD. CONCLUSIONS The incidence of acute AoD increased in France over the period of the study and was associated with stable postoperative early mortality. Early postoperative mortality is significantly reduced in high-volume centers.
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Affiliation(s)
- Anais Lejot
- Department of Vascular Surgery, Aortic Center, University of Lille, Lille, France -
| | - Guillaume Ledieu
- Department of Cardiology, Aortic Center, University of Lille, Lille, France
| | - Xavier Lenne
- Department of Medical Information, University of Lille, Lille, France
- University of Lille, Lille, France
| | - Amelie Bruandet
- Department of Medical Information, University of Lille, Lille, France
- University of Lille, Lille, France
| | - Pascal Delsart
- Department of Cardiology, Aortic Center, University of Lille, Lille, France
| | - Audrey Girard
- Department of Medical Information, University of Lille, Lille, France
- University of Lille, Lille, France
| | - Benjamin Patterson
- Department of Vascular Surgery, University Hospital of Southampton, Southampton, UK
| | - Jonathan Sobocinski
- Department of Vascular Surgery, Aortic Center, University of Lille, Lille, France
- Department of Controlled Drug Delivery Systems and Biomaterials, University of Lille, Lille, France
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Xu W, Haran C, Dean A, Lim E, Bernau O, Mani K, Khanafer A, Pitama S, Khashram M. Acute aortic syndrome: nationwide study of epidemiology, management, and outcomes. Br J Surg 2023; 110:1197-1205. [PMID: 37303206 PMCID: PMC10416687 DOI: 10.1093/bjs/znad162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/03/2023] [Accepted: 05/07/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Epidemiological studies on acute aortic syndrome (AAS) have relied largely on unverified administrative coding, leading to wide-ranging estimates of incidence. This study aimed to evaluate the incidence, management, and outcomes of AAS in Aotearoa New Zealand. METHODS This was a national population-based retrospective study of patients presenting with an index admission of AAS from 2010 to 2020. Cases from the Ministry of Health National Minimum Dataset, National Mortality Collection, and the Australasian Vascular Audit were cross-verified with hospital notes. Poisson regression adjusted for sex and age was used to investigate trends over time. RESULTS During the study interval, 1295 patients presented to hospital with confirmed AAS, including 790 with type A (61.0 per cent) and 505 with type B (39.0 per cent) AAS. A total of 290 patients died out of hospital between 2010 and 2018. The overall incidence of aortic dissection including out-of-hospital cases was 3.13 (95 per cent c.i. 2.96 to 3.30) per 100 000 person-years, and this increased by an average of 3 (95 per cent c.i. 1 to 6) per cent per year after adjustment for age and sex adjustment on Poisson regression, driven by increasing type A cases. Age-standardized rates of disease were higher in men, and in Māori and Pacific populations. The management strategies used, and 30-day mortality rates among patients with type A (31.9 per cent) and B (9.7 per cent) disease have remained constant over time. CONCLUSION Mortality after AAS remains high despite advances over the past decade. The disease incidence and burden are likely to continue to increase with an ageing population. There is impetus now for further work on disease prevention and the reduction of ethnic disparities.
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Affiliation(s)
- William Xu
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Cheyaanthan Haran
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Anastasia Dean
- Department of Vascular Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Eric Lim
- Department of Vascular Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Oliver Bernau
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Kevin Mani
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Adib Khanafer
- Department of Vascular Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Suzanne Pitama
- Māori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Manar Khashram
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
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Weissler EH, Osazuwa-Peters OL, Greiner MA, Hardy NC, Kougias P, O’Brien SM, Mark DB, Jones WS, Secemsky EA, Vekstein AM, Shalhub S, Mussa FF, Patel MR, Vemulapalli S. Initial Thoracic Endovascular Aortic Repair vs Medical Therapy for Acute Uncomplicated Type B Aortic Dissection. JAMA Cardiol 2023; 8:44-53. [PMID: 36334259 PMCID: PMC9637274 DOI: 10.1001/jamacardio.2022.4187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022]
Abstract
Importance Thoracic endovascular aortic repair (TEVAR) has increasingly been used for uncomplicated type B aortic dissection (uTBAD) despite limited supporting data. Objective To assess whether initial TEVAR following uTBAD is associated with reduced mortality or morbidity compared with medical therapy alone. Design, Setting, and Participants This cohort study included Centers for Medicare & Medicaid Services inpatient claims data for adults aged 65 years or older with index admissions for acute uTBAD from January 1, 2011, to December 31, 2018, with follow-up available through December 31, 2019. Exposures Initial TEVAR was defined as TEVAR within 30 days of admission for acute uTBAD. Main Outcomes and Measures Outcomes included all-cause mortality, cardiovascular hospitalizations, aorta-related and repeated aorta-related hospitalizations, and aortic interventions associated with initial TEVAR vs medical therapy. Propensity score inverse probability weighting was used. Results Of 7105 patients with eligible index admissions for acute uTBAD, 1140 (16.0%) underwent initial TEVAR (623 [54.6%] female; median age, 74 years [IQR, 68-80 years]) and 5965 (84.0%) did not undergo TEVAR (3344 [56.1%] female; median age, 76 years [IQR, 69-83 years]). Receipt of TEVAR was associated with region (vs South; Midwest: adjusted odds ratio [aOR], 0.66 [95% CI, 0.53-0.81]; P < .001; Northeast: aOR, 0.63 [95% CI, 0.50-0.79]; P < .001), Medicaid dual eligibility (aOR, 0.76; 95% CI, 0.63-0.91; P = .003), hypertension (aOR, 1.26; 95% CI, 1.03-1.54; P = .03), peripheral vascular disease (aOR, 1.24; 95% CI, 1.02-1.49; P = .03), and year of admission (2012, 2013, 2014, and 2015 were associated with greater odds of TEVAR compared with 2011). After inverse probability weighting, mortality was similar for the 2 strategies up to 5 years (hazard ratio [HR], 0.95; 95% CI, 0.85-1.06), as were aorta-related hospitalizations (HR, 1.12; 95% CI, 0.99-1.27), aortic interventions (HR, 1.01; 95% CI, 0.84-1.20), and cardiovascular hospitalizations (HR, 1.05; 95% CI, 0.93-1.20). In a sensitivity analysis that included deaths within the first 30 days, initial TEVAR was associated with lower mortality over a period of 1 year (adjusted HR [aHR], 0.86; 95% CI, 0.75-0.99; P = .03), 2 years (aHR, 0.85; 95% CI, 0.75-0.96; P = .008), and 5 years (aHR, 0.87; 95% CI, 0.80-0.96; P = .004). Conclusions and Relevance In this study, 16.0% of patients underwent initial TEVAR within 30 days of uTBAD, and receipt of initial TEVAR was associated with hypertension, peripheral vascular disease, region, Medicaid dual eligibility, and year of admission. Initial TEVAR was not associated with improved mortality or reduced hospitalizations or aortic interventions over a period of 5 years, but in a sensitivity analysis that included deaths within the first 30 days, initial TEVAR was associated with lower mortality. These findings, along with cost-effectiveness and quality of life, should be assessed in a prospective trial in the US population.
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Affiliation(s)
- E. Hope Weissler
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Melissa A. Greiner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - N. Chantelle Hardy
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Panagiotis Kougias
- Division of Vascular and Endovascular Surgery, SUNY Downstate Health Sciences University, Brooklyn, New York
| | | | - Daniel B. Mark
- Duke Clinical Research Institute, Durham, North Carolina
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - W. Schuyler Jones
- Duke Clinical Research Institute, Durham, North Carolina
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Eric A. Secemsky
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Andrew M. Vekstein
- Duke Clinical Research Institute, Durham, North Carolina
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Sherene Shalhub
- Division of Vascular Surgery, University of Washington, Seattle
| | - Firas F. Mussa
- Section of Vascular Surgery, Imperial College London, London, England
| | - Manesh R. Patel
- Duke Clinical Research Institute, Durham, North Carolina
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Durham, North Carolina
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
- Duke University Medical Center, Durham, North Carolina
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Treffalls JA, Sylvester CB, Parikh U, Zea-Vera R, Ryan CT, Zhang Q, Rosengart TK, Wall MJ, Coselli JS, Chatterjee S, Ghanta RK. Nationwide database analysis of one-year readmission rates after open surgical or thoracic endovascular repair of Stanford Type B aortic dissection. JTCVS OPEN 2022; 11:1-13. [PMID: 36172436 PMCID: PMC9510909 DOI: 10.1016/j.xjon.2022.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/15/2022] [Accepted: 06/28/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE We examined readmissions and resource use during the first postoperative year in patients who underwent thoracic endovascular aortic repair or open surgical repair of Stanford type B aortic dissection. METHODS The Nationwide Readmissions Database (2016-2018) was queried for patients with type B aortic dissection who underwent thoracic endovascular aortic repair or open surgical repair. The primary outcome was readmission during the first postoperative year. Secondary outcomes included 30-day and 90-day readmission rates, in-hospital mortality, length of stay, and cost. A Cox proportional hazards model was used to determine risk factors for readmission. RESULTS During the study period, type B aortic dissection repair was performed in 6456 patients, of whom 3517 (54.5%) underwent thoracic endovascular aortic repair and 2939 (45.5%) underwent open surgical repair. Patients undergoing thoracic endovascular aortic repair were older (63 vs 59 years; P < .001) with fewer comorbidities (Elixhauser score of 11 vs 17; P < .001) than patients undergoing open surgical repair. Thoracic endovascular aortic repair was performed electively more often than open surgical repair (29% vs 20%; P < .001). In-hospital mortality was 9% overall and lower in the thoracic endovascular aortic repair cohort than in the open surgical repair cohort (5% vs 13%; P < .001). However, the 90-day readmission rate was comparable between the thoracic endovascular aortic repair and open surgical repair cohorts (28% vs 27%; P = .7). Freedom from readmission for up to 1 year was also similar between cohorts (P = .6). Independent predictors of 1-year readmission included length of stay more than 10 days (P = .005) and Elixhauser comorbidity risk index greater than 4 (P = .033). CONCLUSIONS Approximately one-third of all patients with type B aortic dissection were readmitted within 90 days after aortic intervention. Surprisingly, readmission during the first postoperative year was similar in the open surgical repair and thoracic endovascular aortic repair cohorts, despite marked differences in preoperative patient characteristics and interventions.
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Key Words
- AHRQ, Agency for Healthcare Research and Quality
- CI, confidence interval
- HR, hazard ratio
- ICD-10-CM, International Classification of Diseases, Tenth Revision, Clinical Modification
- IQR, interquartile range
- LOS, length of stay
- NRD, Nationwide Readmissions Database
- OSR, open surgical repair
- TBAD, type B aortic dissection
- TEVAR, thoracic endovascular aortic repair
- nationwide readmissions database
- readmissions
- thoracic endovascular aortic repair
- thoracoabdominal aortic dissection
- type B aortic dissection
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Affiliation(s)
- John A. Treffalls
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Tex
| | - Christopher B. Sylvester
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Department of Bioengineering, Rice University, Houston, Tex
- Medical Scientist Training Program, Baylor College of Medicine, Houston, Tex
| | - Umang Parikh
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Rodrigo Zea-Vera
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Christopher T. Ryan
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Qianzi Zhang
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Todd K. Rosengart
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex
| | - Matthew J. Wall
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Joseph S. Coselli
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex
| | - Subhasis Chatterjee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex
| | - Ravi K. Ghanta
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex
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Fibrillin-1 Gene Polymorphisms (rs145233125, rs11070646, rs201170905) Are Associated With the Susceptibility and Clinical Prognosis of DeBakey Type III Aortic Dissection in Chinese Han Population. J Cardiovasc Pharmacol 2022; 80:118-124. [PMID: 35500095 DOI: 10.1097/fjc.0000000000001282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/30/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT We aim to investigate whether genetic variants of the Fibrillin-1 (FBN1) gene were associated with DeBakey type III aortic dissection (AD) and its clinical prognosis in Chinese Han population. Three single-nucleotide polymorphisms (SNPs) (rs145233125, rs11070646, rs201170905) in FBN1 were analyzed in patients with DeBakey type III AD (159) and healthy subjects (216). Gene-environment interactions were evaluated to use generalized multifactor dimensionality reduction. Haplotype analysis of the 3 SNPs in the FBN1 gene was performed by Haploview software. Patients were followed up for average 4 years. G carriers of rs11070646 and rs201170905 in FBN1 have an increased risk of DeBakey type III AD. The interaction of FBN1 and environmental factors facilitated to the increased risk of DeBakey type III AD (cross-validation consistency = 10/10, P = 0.001). One of the most common haplotypes revealed an increased risk of DeBakey type III AD (CGG, P = 0.009). Recessive models of rs145233125 CC genotype ( P < 0.05) and rs201170905 GG genotype ( P < 0.001) were associated with an increased risk of death and recurrent chest pain of DeBakey type III AD. In conclusions, FBN1 gene polymorphisms contribute to DeBakey type III AD susceptibility. The interactions of gene and environment are related with the risk of DeBakey type III AD. C carriers of rs145233125 and G carriers of rs201170905 may be the adverse prognostic indicators of death and recurrent chest pain in DeBakey type III AD.
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Williamson AJ, Sankary S, Kuchta KM, Gaines S, Morcos O, Lind B, Pocivavsek L, Dua A, Lee CJ. Contemporary Unplanned Readmission Trends Following Management of Type B Aortic Dissection. Vasc Specialist Int 2022; 38:16. [PMID: 35748179 PMCID: PMC9233985 DOI: 10.5758/vsi.220007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/09/2022] [Accepted: 04/14/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- Ashley J. Williamson
- Division of Vascular Surgery, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Seth Sankary
- Division of Vascular Surgery, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Kristine Marie Kuchta
- Division of Vascular Surgery, Department of Surgery, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, IL, USA
| | - Sara Gaines
- Division of Vascular Surgery, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Omar Morcos
- Division of Vascular Surgery, Department of Surgery, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, IL, USA
| | - Benjamin Lind
- Division of Vascular Surgery, Department of Surgery, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, IL, USA
| | - Luka Pocivavsek
- Division of Vascular Surgery, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Anahita Dua
- Division of Vascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Cheong J. Lee
- Division of Vascular Surgery, Department of Surgery, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, IL, USA
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9
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Duke JM, Reed AB, Valentine RJ. Emergency Department Visits After Acute Aortic Syndromes. J Vasc Surg 2022; 76:373-377. [PMID: 35182662 DOI: 10.1016/j.jvs.2022.01.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Recent reports document a high rate of readmission after hospitalization for acute aortic syndromes (AAS) that include acute aortic dissections (AD), intramural hematomas (IMH), or penetrating aortic ulcers (PAU). We examined the rate of return to the emergency department (ED) to better understand the utilization of emergent health care services after AAS. METHODS Consecutive AAS patients admitted to the vascular surgery service from 2004 to 2020 were included. Patients with type A dissections, arch involvement, or chronic aortic pathology were excluded. The primary outcome was ED visits within 90 days of the original hospitalization. RESULTS The study included 79 subjects (62% men, 38% women; mean age, 64+14 years) with AAS (82% AD, 11% IMH, 6% PAU). A total of 54 ED visits related to the AAS occurred within 90 days of the original discharge, each of which incurred a CT angiogram. Twenty-eight (35%) subjects had a mean of 2+2 ED visits, while 51 (65%) subjects had no ED visits. Ninety percent (25/28) of the first ED visits occurred within 1 month of discharge and 53% (15/28) within one week. 17 (61%) subjects were readmitted to the hospital from the ED. Four subjects were found to have progression of AAS on imaging studies and underwent TEVAR during readmission. Comparing subjects who returned to the ED to those who did not, there were no significant differences in demographics, atherosclerotic risk factors except coronary artery disease, type of AAS, number of antihypertensive medications at admission or discharge, operative intervention, length of initial hospital stay, or discharge status. The chief complaint at the first ED visit was pain (n=17), uncontrolled hypertension (n=5), syncope (n=3), and other (n=3). CONCLUSIONS These data show that one in three patients with AAS returned to the ED within 90 days of initial discharge. Although returning subjects had a higher number of readmissions, few had progression of AAS that required intervention. Because the vast majority were readmitted for medical therapy, early and frequent clinic follow up may help decrease ED visits and readmissions after AAS.
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Affiliation(s)
- Julie M Duke
- Division of Vascular Surgery, Department of Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota.
| | - Amy B Reed
- Division of Vascular Surgery, Department of Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - R James Valentine
- Division of Vascular Surgery, Department of Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota
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Ninety-Day Readmission After Open Surgical Repair of Stanford Type A Aortic Dissection. Ann Thorac Surg 2021; 113:1971-1978. [PMID: 34331934 DOI: 10.1016/j.athoracsur.2021.06.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/20/2021] [Accepted: 06/18/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Investigations into readmissions after surgical repair of acute Stanford Type A aortic dissection (TAAD) remain scarce. We analyzed potential risk factors for readmission after TAAD. METHODS The 2013-2014 United States Nationwide Readmissions Database was queried for TAAD index hospitalizations and 90-day readmissions indicated by diagnostic and procedural codes. Multivariable analysis was completed to identify risk factors and the most common reasons for readmission. RESULTS We identified 6,975 patients (65% male; age, 60.0±0.4 years) who underwent surgical repair for TAAD. Overall, 2,062 patients (29.6%) were readmitted within 90 days: 634 (30.7%) during the first 30 days, and 1,428 (69.3%) during days 31-90. Readmitted patients had a higher prevalence of chronic kidney disease at index admission (18.0% vs 11.6%, P=.002), greater overall index length of stay (17.8±0.6 vs 15.5±0.4 days; P=.0003), and greater index hospitalization cost ($90,637±$2,691 vs $80,082±$2,091; P=.0003). Mortality during readmission was 3.6% (n=74). Indications for readmission were most commonly cardiac (26.2%), infectious (17.8%), and pulmonary (11.7%). Multivariable analysis identified 2 independent risk factors for readmission: acute kidney injury (OR 1.49; 95% CI 1.24-1.78, P<.0001) and an Elixhauser Comorbidity Index >4 (OR 1.26; 95% CI 1.06-1.49, P=.009). CONCLUSIONS After surgical repair of TAAD, approximately 30% of patients were readmitted within 90 days, two thirds of them during the 31- to 90-day period. Targeted improvements in perioperative care and post-discharge follow-up of patients with multiple comorbidities could mitigate readmission rates. Efforts to reduce readmissions should be continued throughout the 90-day period.
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11
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Weissler EH, Osazuwa-Peters OL, Greiner MA, Hughes GC, Long CA, Vemulapalli S, Patel MR, Jones WS. National trends in repair for type B aortic dissection. Clin Cardiol 2021; 44:1058-1068. [PMID: 34173677 PMCID: PMC8364733 DOI: 10.1002/clc.23672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background Thoracic endovascular aortic repair (TEVAR) first gained in popularity for repair of type B aortic dissections (TBADs) in the early 2000's. We aimed to describe patients undergoing open repair, TEVAR, and no repair and analyze factors associated with repair within 14 days of presentation in the contemporary era. Methods We used the MarketScan database to find patients with TBAD between 2014 and 2017. To assess factors associated with early repair, univariable, and multivariable log‐binomial regression were used. Results There were 2613 patients admitted with TBAD between 2014 and 2017 across the United States, of whom 38.4% underwent repair within 14 days of admission (25.3% open repair and 13.1% TEVAR). The incidence of repair within 14 days decreased over the study period (43% of the study cohort in 2014 to 26.4% in 2017) primarily due to a decrease in open repairs from 30.8% of patients in 2014 to 12.5% in 2017. In multivariable analysis, older age, Middle Atlantic location, diabetes mellitus, insulin use, antiplatelet use, and more recent year were associated with lower likelihood of early repair; male sex, peripheral vascular disease, and the presence of extremity ischemia, rupture, shock, and acidosis were associated with higher likelihood of repair. Conclusions Overall, repair of TBAD within 14 days of presentation declined from 2014 to 2017, with a steady rate of TEVAR but declining rate of open repairs. Further investigation into provider‐ and hospital‐specific factors as they relate to likelihood of repair is needed.
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Affiliation(s)
- E Hope Weissler
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Oyomoare L Osazuwa-Peters
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Melissa A Greiner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Chandler A Long
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sreekanth Vemulapalli
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Manesh R Patel
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - W Schuyler Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
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Ando T, Adegbala O, Aggarwal A, Afonso L, Grines CL, Takagi H, Briasoulis A. Unplanned Thirty-Day Readmission After Alcohol Septal Ablation for Hypertrophic Cardiomyopathy (From the Nationwide Readmission Database). Am J Cardiol 2020; 125:1890-1895. [PMID: 32305221 DOI: 10.1016/j.amjcard.2020.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/13/2020] [Accepted: 03/19/2020] [Indexed: 11/19/2022]
Abstract
Alcohol septal ablation (ASA) is indicated for symptomatic hypertrophic cardiomyopathy (HC) patients. We sought to analyze the incidence of the 30-day readmission rate, predictors, causes of readmission, and incremental healthcare resource (cost and length of stay) utilization after ASA. Nationwide Readmission Database from 2010 January to 2015 September was queried to identify 30-day unplanned readmission after ASA for HC by using the International Classification of Disease, 9th Revision, Clinical Modification. Those readmitted were similar in terms of age and sex but had higher burden of co-morbidities compared with those not readmitted within 30-days. The 30-day unplanned readmission rate was 10.4% (511/4,932) after ASA. Readmissions lead to an additional mean hospitalization cost of 8,433 US dollars and mean of 4.9 days of length of stay. Predictors of 30-day unplanned readmission were liver disease (adjusted odds ratio [aOR] 2.62, 95% confidence interval [CI] 1.22 to 5.59), renal failure (aOR 2.30, 95%CI 1.52 to 3.50), previous myocardial infarction (aOR 1.97, 95%CI 1.16 to 3.33), previous pacemaker (aOR 1.50, 95%CI 1.09 to 2.08), atrial fibrillation (aOR 1.43, 95%CI 1.08 to 1.89), Medicaid (aOR 1.74, 95%CI 1.12 to 2.68), and weekend admission (aOR 1.75, 95%CI 1.12 to 2.75). Common reasons for readmissions were atrial fibrillation (12.6%), acute on chronic systolic heart failure (12.6%), paroxysmal ventricular tachycardia (6.4%), atrioventricular block (4.9%), and HC (3.0%). Unplanned readmissions after ASA occur in patients with higher burden of co-morbidities and are mainly caused by cardiac etiologies.
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Affiliation(s)
- Tomo Ando
- Division of Cardiology, Center for Interventional Vascular Therapy, New York-Presbyterian Hospital/Columbia University Medical Center, Detroit, Michigan.
| | - Oluwole Adegbala
- Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Ankita Aggarwal
- Wayne State University School of Medicine/Ascension Providence Rochester Hospital
| | - Luis Afonso
- Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Cindy L Grines
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia
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