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Home > Vascular Annual Meeting > PP18. The Effect of Ethnicity And Insurance Type...

PP18. The Effect of Ethnicity And Insurance Type in the Early Adoption of Thoracic Endovascular Repair (TEVAR)

Frank R. Arko, III, Erin H. Murphy, Charles M. Davis, Stephen T. Smith, J. Gregory Modrall, G. Patrick Clagett
University of Texas Southwestern Medical Center, Dallas, TX

OBJECTIVES: Mortality and complication rates for open thoracic aortic aneurysm repair have declined but still remain high. Recently with the introduction of TEVAR morbidity and mortality have improved, but in a large general population are unknown. The purpose of this study is to determine the influence of ethnicity and insurance type on procedure selection and outcome following TEVAR.

METHODS: Using the Nationwide Inpatient Sample (NIS) database ethnicity and insurance type were evaluated against the outcome variables of mortality and complications associated with thoracic aneurysm repair.

RESULTS: Between 2001-2005, a total of 875 patients undergoing TEVAR were analyzed with a significantly greater proportion of Caucasians over African Americans and Hispanics (650, 104, and 49, respectively) with 72 patients categorized as other. The majority of subjects in all races were male and most of the procedures were elective. The overall mortality was 13.3% (n=117) and spinal cord ischemia was 0.8% (n=7) with no difference between ethnicity and insurance type. Significant differences were notable in all demographic characteristics among races including gender (p=0.003), income (p<0.0001), hospital region of surgery (p<0.001), hospital bed size (p=0.013), and insurance type (p<0.001). Variations in demographic characteristics were also present in the univariate analysis associated with insurance classifications with significant differences in gender (p<0.001), surgery type (p=0.009), income (p=0.003), race p<0.0001) and comorbidity index (p<0.0001). Bivariate analysis by race resulted in few statistically significant differences except for infection (p=0.007) and other complications (p=0.003) with African Americans and Hispanics having a higher incidence respectively. Bivariate comparison by insurance resulted in a greater number of significant differences including nonroutine discharge (p=0.009), intestinal ischemia (p=0.039), and transfusions (p=0.003).

CONCLUSIONS: There is a significant difference in ethnicity in the repair of thoracic aneurysms but no difference in mortality among groups. The incidence of spinal cord ischemia is very low with no difference between groups. Ethnicity and type of insurance is associated with a higher risk of complications with TEVAR.

AUTHOR DISCLOSURES: F.R. Arko, None; E.H. Murphy, None; C.M. Davis, None; S.T. Smith, None; J.G. Modrall, None; G.P. Clagett, None.