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Home > Vascular Annual Meeting^® > RR30. Early Outcomes Following Endografting...

RR30. Early Outcomes Following Endografting or Open Surgery for Thoracic Aortic Pathology: Data from the National Surgical Quality Improvement Project

David A. Peterson, Hardeep Ahluwalia, Mihir Gandhi, Sonny Tucker, Leila Mureebe, Cynthia K. Shortell
Duke University Medical Center, Durham, NC

OBJECTIVES: Literature comparing thoracic endografting (TEVAR) to OPEN surgery for thoracic aortic pathology includes reports from single institutions or industry-maintained registries focusing on aneurysmal disease. We hypothesized that early outcomes are improved in patients undergoing TEVAR rather than OPEN repair of thoracic aortic pathology, based on independent, multicenter data.

METHODS: Patients who underwent TEVAR or OPEN repair of thoracic aortic pathology (aneurysms, ruptured aneurysms, dissections or traumatic injuries) from 2006 to 2008 were identified in the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database. Data collection included: 30 day mortality; confounding variables (age, gender, American Society of Anesthesiologists class, diabetes, serum albumin, renal function, and cardiopulmonary status); intra- and post-operative outcomes. Inferential statistics and generalized linear models were used to compare TEVAR and OPEN outcomes.

RESULTS: Two hundred sixty-nine (n=269) patients underwent repair of thoracic aortic pathology (TEVAR: 139 vs. OPEN: 130). Two hundred and seven (77%) patients had intact aneurysms, 42 (16%) had dissections or traumatic injuries, and 20 (7%) had ruptured aneurysms. Bivariate analysis revealed no significant differences in 30 day mortality (TEVAR: 9 [4%] vs. Open: 11 [5%]). Adjusted outcomes demonstrated significant decreases (p<0.05) in TEVAR: length of stay (median (med) TEVAR: 6.5 days, 95% confidence interval (CI): 5.2, 7.8 vs. OPEN: 14.7 days, CI: 13.2, 16.2); operative time (med: 141 minutes, CI: 117, 165 vs. 355 minutes, CI: 348, 401); occurrence of post-operative pneumonia (n=11 [8%] vs. 47 [36%], odds ratio (OR): 0.16, CI: 0.06, 0.42 ); reintubation (N=11 [8%] vs. 25 [19%], OR: 0.21 , CI: 0.06, 0.68 ); and acute renal failure (n=4 [3%] vs. 16 [12%], OR: 0.11, CI: 0.02, 0.64 ).

CONCLUSIONS: Among patients undergoing repair of thoracic aortic pathology, TEVAR is associated with similar mortality but decreased early morbidity, operative time, and length of stay when compared to OPEN surgery. These findings suggest that broader adoption of TEVAR for thoracic aortic disease will lead to reductions in early morbidity, operative time, and length of stay associated with repair.

AUTHOR DISCLOSURES: D.A. Peterson, None; H. Ahluwalia, None; M. Gandhi, None; S. Tucker, None; L. Mureebe, None; C.K. Shortell, BTG Varisolve Advisory Board Member.