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Abstract
Objective To quantify contemporary outcomes following elective ascending aortic aneurysm repair, to determine risk factors for adverse events and to evaluate difference by institutional surgical volume.
Methods We included all elective hospitalisations of adult patients with an ascending aortic aneurysm who underwent aneurysm repair in the Nationwide Readmissions Database between 2016 and 2019. The primary outcome was a composite of in-hospital mortality, stroke (ischaemic and non-ischaemic) and myocardial infarction (MI). We identified independent predictor of adverse events and investigated outcomes by institutional volume.
Results Among 12 043 patients (mean 62.8 years of age, 28.0% female), MI, stroke or in-hospital death occurred in 598 (4.9%) patients during the index admission (acute stroke: 2.7%, MI: 0.7%, in-hospital death: 2.0%). The strongest predictors of in-hospital death, stroke or MI were chronic weight loss, pulmonary circulation disorder and concomitant descending aortic surgery. Higher procedural volume was associated with a lower incidence of in-hospital death, stroke or MI (OR comparing the highest with the lowest tertile 0.71, 95% CI 0.57 to 0.87; p=0.001) and in-hospital death (OR 0.51, 95% CI 0.37 to 0.72; p<0.001), but no difference in 30-day readmissions.
Conclusions The overall rate of in-hospital death, stroke and MI is nearly 5% in patients undergoing elective ascending aortic aneurysm repair. Among several predictors, chronic weight loss is associated with the largest increase in the risk of poor outcomes. Higher hospital volume is associated with a lower in-hospital mortality, highlighting the importance to refer patients to high-volume centres while discussing the risks and benefits of proceeding with repair.
- aortic aneurysm
- outcome assessment, health care
Data availability statement
Data may be obtained from a third party and are not publicly available. The database used for this analysis (Nationwide Readmissions Database) can be obtained from the Hospital Cost and Utilisation Project (HCUP, https://www.hcup-us.ahrq.gov/databases.jsp).
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Data availability statement
Data may be obtained from a third party and are not publicly available. The database used for this analysis (Nationwide Readmissions Database) can be obtained from the Hospital Cost and Utilisation Project (HCUP, https://www.hcup-us.ahrq.gov/databases.jsp).
Footnotes
Contributors SEB contributed to the conceptualisation, data curation, formal analysis, investigation and writing of the original draft. EAS contributed to the conceptualisation, funding acquisition, methodology and writing of the original draft. KK contributed to the conceptualisation and writing of the original draft. BJC contributed to the conceptualisation, methodology and writing of the original draft, and is responsible for the overall content as guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests EAS reports institutional research support from NIH/NHLBI (K23HL150290), Food & Drug Administration, BD, Boston Scientific, Cook, CSI, Laminate Medical, Medtronic and Philips. He is a consultant/speaker for Abbott, Bayer, BD, Boston Scientific, Cook, CSI, Medtronic, Philips and VentrureMed. BJC reports institutional research support from Bristol-Myers Squibb and Inari. He is a consultant for Reliant Medical and Janssen.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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