Nationwide trends and regional/hospital variations in open versus endovascular repair of thoracoabdominal aortic aneurysms
Objectives Thoracic endovascular aortic repair (TEVAR) has been gaining popularity for the treatment of thoracoabdominal aortic aneurysm (TAAA). We used a nonvoluntary database to examine national trends and regional/hospital variations in the use of TEVAR and open thoracic aortic repair (OTAR) for...
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| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2012-09, Vol.144 (3), p.612-616 |
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| container_title | The Journal of thoracic and cardiovascular surgery |
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| creator | Liao, Joshua M., BS Bakaeen, Faisal G., MD Cornwell, Lorraine D., MD Simpson, Kiki, MS LeMaire, Scott A., MD Coselli, Joseph S., MD Chu, Danny, MD |
| description | Objectives Thoracic endovascular aortic repair (TEVAR) has been gaining popularity for the treatment of thoracoabdominal aortic aneurysm (TAAA). We used a nonvoluntary database to examine national trends and regional/hospital variations in the use of TEVAR and open thoracic aortic repair (OTAR) for TAAA. Methods From the 2005-2008 Nationwide Inpatient Sample database, we identified all patients with the diagnosis of TAAA who were treated with TEVAR or OTAR. Rates of these procedures were compared between years, across geographic regions, and between hospitals of various bed sizes. Results Over the study period, the rate of OTAR remained relatively stable (range, 7.5/100 patients in 2005 to 10.1/100 patients in 2008; P = .26), whereas the rate of TEVAR increased dramatically (range, 1.4/100 patients in 2005 to 6.3/100 patients in 2008; P |
| doi_str_mv | 10.1016/j.jtcvs.2011.10.098 |
| format | Article |
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We used a nonvoluntary database to examine national trends and regional/hospital variations in the use of TEVAR and open thoracic aortic repair (OTAR) for TAAA. Methods From the 2005-2008 Nationwide Inpatient Sample database, we identified all patients with the diagnosis of TAAA who were treated with TEVAR or OTAR. Rates of these procedures were compared between years, across geographic regions, and between hospitals of various bed sizes. Results Over the study period, the rate of OTAR remained relatively stable (range, 7.5/100 patients in 2005 to 10.1/100 patients in 2008; P = .26), whereas the rate of TEVAR increased dramatically (range, 1.4/100 patients in 2005 to 6.3/100 patients in 2008; P < .0001). In 2008, 29% (211) of all TEVAR procedures and 11% (130) of all OTAR procedures were performed in western regions of the United States ( P = .03). Additionally, 13% (95) of all TEVAR procedures and 3% (35) of all OTAR procedures were performed in smaller hospitals ( P < .0001). Conclusions The use of TEVAR for TAAA repair increased significantly over the study period, whereas OTAR rates remained relatively stable. Our findings suggest that more patients who were otherwise not surgical candidates or did not have traditional surgical indications for OTAR were treated with TEVAR, most commonly in regions or hospitals where OTAR is less often performed. Given the complexity of TAAA cases, these results may have significant implications for patient safety in the current era of heightened health care scrutiny.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2011.10.098</identifier><identifier>PMID: 22898505</identifier><identifier>CODEN: JTCSAQ</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Aortic Aneurysm, Thoracic - mortality ; Aortic Aneurysm, Thoracic - surgery ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood Vessel Prosthesis Implantation - adverse effects ; Blood Vessel Prosthesis Implantation - mortality ; Blood Vessel Prosthesis Implantation - trends ; Cardiology. Vascular system ; Cardiothoracic Surgery ; Chi-Square Distribution ; Databases, Factual - trends ; Diseases of the aorta ; Endovascular Procedures - adverse effects ; Endovascular Procedures - mortality ; Endovascular Procedures - trends ; Healthcare Disparities - trends ; Hospital Bed Capacity - statistics & numerical data ; Hospitals - trends ; Humans ; Inpatients - statistics & numerical data ; Medical sciences ; Patient Safety - statistics & numerical data ; Pneumology ; Residence Characteristics - statistics & numerical data ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome ; United States - epidemiology</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2012-09, Vol.144 (3), p.612-616</ispartof><rights>2012</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2012. Published by Mosby, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c489t-355caf20d89f6b08c3fa3d2538f0589ab646028db23b416d84800d955cd816b53</citedby><cites>FETCH-LOGICAL-c489t-355caf20d89f6b08c3fa3d2538f0589ab646028db23b416d84800d955cd816b53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jtcvs.2011.10.098$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3548,27923,27924,45994</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26285380$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22898505$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Liao, Joshua M., BS</creatorcontrib><creatorcontrib>Bakaeen, Faisal G., MD</creatorcontrib><creatorcontrib>Cornwell, Lorraine D., MD</creatorcontrib><creatorcontrib>Simpson, Kiki, MS</creatorcontrib><creatorcontrib>LeMaire, Scott A., MD</creatorcontrib><creatorcontrib>Coselli, Joseph S., MD</creatorcontrib><creatorcontrib>Chu, Danny, MD</creatorcontrib><title>Nationwide trends and regional/hospital variations in open versus endovascular repair of thoracoabdominal aortic aneurysms</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Objectives Thoracic endovascular aortic repair (TEVAR) has been gaining popularity for the treatment of thoracoabdominal aortic aneurysm (TAAA). We used a nonvoluntary database to examine national trends and regional/hospital variations in the use of TEVAR and open thoracic aortic repair (OTAR) for TAAA. Methods From the 2005-2008 Nationwide Inpatient Sample database, we identified all patients with the diagnosis of TAAA who were treated with TEVAR or OTAR. Rates of these procedures were compared between years, across geographic regions, and between hospitals of various bed sizes. Results Over the study period, the rate of OTAR remained relatively stable (range, 7.5/100 patients in 2005 to 10.1/100 patients in 2008; P = .26), whereas the rate of TEVAR increased dramatically (range, 1.4/100 patients in 2005 to 6.3/100 patients in 2008; P < .0001). In 2008, 29% (211) of all TEVAR procedures and 11% (130) of all OTAR procedures were performed in western regions of the United States ( P = .03). Additionally, 13% (95) of all TEVAR procedures and 3% (35) of all OTAR procedures were performed in smaller hospitals ( P < .0001). Conclusions The use of TEVAR for TAAA repair increased significantly over the study period, whereas OTAR rates remained relatively stable. Our findings suggest that more patients who were otherwise not surgical candidates or did not have traditional surgical indications for OTAR were treated with TEVAR, most commonly in regions or hospitals where OTAR is less often performed. Given the complexity of TAAA cases, these results may have significant implications for patient safety in the current era of heightened health care scrutiny.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Aortic Aneurysm, Thoracic - mortality</subject><subject>Aortic Aneurysm, Thoracic - surgery</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Blood Vessel Prosthesis Implantation - adverse effects</subject><subject>Blood Vessel Prosthesis Implantation - mortality</subject><subject>Blood Vessel Prosthesis Implantation - trends</subject><subject>Cardiology. Vascular system</subject><subject>Cardiothoracic Surgery</subject><subject>Chi-Square Distribution</subject><subject>Databases, Factual - trends</subject><subject>Diseases of the aorta</subject><subject>Endovascular Procedures - adverse effects</subject><subject>Endovascular Procedures - mortality</subject><subject>Endovascular Procedures - trends</subject><subject>Healthcare Disparities - trends</subject><subject>Hospital Bed Capacity - statistics & numerical data</subject><subject>Hospitals - trends</subject><subject>Humans</subject><subject>Inpatients - statistics & numerical data</subject><subject>Medical sciences</subject><subject>Patient Safety - statistics & numerical data</subject><subject>Pneumology</subject><subject>Residence Characteristics - statistics & numerical data</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>United States - epidemiology</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkl-L1TAQxYso7nX1EwiSF8GX3p2kbTZ9UJDFf7Dogwq-hTRJ3dS2qZm2cv30TvdeFXzxKTD8zsyck8myxxz2HLi86PbdbFfcC-CcKnuo1Z1sx6G-zKWqvtzNdgBC5JUQxVn2ALEDgEvg9f3sTAhVqwqqXfbzvZlDHH8E59mc_OiQmdGx5L9S1fQXNxGnMJuerSaFWxRZGFmc_MhWn3BBRqK4GrRLbxIJJxMSiy2bb2IyNprGxSFQK2ZimoOl9n5JBxzwYXavNT36R6f3PPv8-tWnq7f59Yc3765eXue2VPWcF1VlTSvAqbqVDShbtKZwoipUC5WqTSNLCUK5RhRNyaVTpQJwNamc4rKpivPs2bHvlOL3xeOsh4DW9z1tEhfUHIpSAFS1JLQ4ojZFxORbPaUwmHQgSG-h607fhq630LcihU6qJ6cBSzN490fzO2UCnp4Aisn0bTKjDfiXk0KRHSDu-ZHzFMcafNJogx-tdyF5O2sXw38WefGP3vZhDDTymz947OKS6CPIsUahQX_c7mM7D072pRJl8Qul3rh4</recordid><startdate>20120901</startdate><enddate>20120901</enddate><creator>Liao, Joshua M., BS</creator><creator>Bakaeen, Faisal G., MD</creator><creator>Cornwell, Lorraine D., MD</creator><creator>Simpson, Kiki, MS</creator><creator>LeMaire, Scott A., MD</creator><creator>Coselli, Joseph S., MD</creator><creator>Chu, Danny, MD</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120901</creationdate><title>Nationwide trends and regional/hospital variations in open versus endovascular repair of thoracoabdominal aortic aneurysms</title><author>Liao, Joshua M., BS ; Bakaeen, Faisal G., MD ; Cornwell, Lorraine D., MD ; Simpson, Kiki, MS ; LeMaire, Scott A., MD ; Coselli, Joseph S., MD ; Chu, Danny, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c489t-355caf20d89f6b08c3fa3d2538f0589ab646028db23b416d84800d955cd816b53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Aortic Aneurysm, Thoracic - mortality</topic><topic>Aortic Aneurysm, Thoracic - surgery</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Blood Vessel Prosthesis Implantation - adverse effects</topic><topic>Blood Vessel Prosthesis Implantation - mortality</topic><topic>Blood Vessel Prosthesis Implantation - trends</topic><topic>Cardiology. Vascular system</topic><topic>Cardiothoracic Surgery</topic><topic>Chi-Square Distribution</topic><topic>Databases, Factual - trends</topic><topic>Diseases of the aorta</topic><topic>Endovascular Procedures - adverse effects</topic><topic>Endovascular Procedures - mortality</topic><topic>Endovascular Procedures - trends</topic><topic>Healthcare Disparities - trends</topic><topic>Hospital Bed Capacity - statistics & numerical data</topic><topic>Hospitals - trends</topic><topic>Humans</topic><topic>Inpatients - statistics & numerical data</topic><topic>Medical sciences</topic><topic>Patient Safety - statistics & numerical data</topic><topic>Pneumology</topic><topic>Residence Characteristics - statistics & numerical data</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Liao, Joshua M., BS</creatorcontrib><creatorcontrib>Bakaeen, Faisal G., MD</creatorcontrib><creatorcontrib>Cornwell, Lorraine D., MD</creatorcontrib><creatorcontrib>Simpson, Kiki, MS</creatorcontrib><creatorcontrib>LeMaire, Scott A., MD</creatorcontrib><creatorcontrib>Coselli, Joseph S., MD</creatorcontrib><creatorcontrib>Chu, Danny, MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Liao, Joshua M., BS</au><au>Bakaeen, Faisal G., MD</au><au>Cornwell, Lorraine D., MD</au><au>Simpson, Kiki, MS</au><au>LeMaire, Scott A., MD</au><au>Coselli, Joseph S., MD</au><au>Chu, Danny, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Nationwide trends and regional/hospital variations in open versus endovascular repair of thoracoabdominal aortic aneurysms</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2012-09-01</date><risdate>2012</risdate><volume>144</volume><issue>3</issue><spage>612</spage><epage>616</epage><pages>612-616</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><coden>JTCSAQ</coden><abstract>Objectives Thoracic endovascular aortic repair (TEVAR) has been gaining popularity for the treatment of thoracoabdominal aortic aneurysm (TAAA). We used a nonvoluntary database to examine national trends and regional/hospital variations in the use of TEVAR and open thoracic aortic repair (OTAR) for TAAA. Methods From the 2005-2008 Nationwide Inpatient Sample database, we identified all patients with the diagnosis of TAAA who were treated with TEVAR or OTAR. Rates of these procedures were compared between years, across geographic regions, and between hospitals of various bed sizes. Results Over the study period, the rate of OTAR remained relatively stable (range, 7.5/100 patients in 2005 to 10.1/100 patients in 2008; P = .26), whereas the rate of TEVAR increased dramatically (range, 1.4/100 patients in 2005 to 6.3/100 patients in 2008; P < .0001). In 2008, 29% (211) of all TEVAR procedures and 11% (130) of all OTAR procedures were performed in western regions of the United States ( P = .03). Additionally, 13% (95) of all TEVAR procedures and 3% (35) of all OTAR procedures were performed in smaller hospitals ( P < .0001). Conclusions The use of TEVAR for TAAA repair increased significantly over the study period, whereas OTAR rates remained relatively stable. Our findings suggest that more patients who were otherwise not surgical candidates or did not have traditional surgical indications for OTAR were treated with TEVAR, most commonly in regions or hospitals where OTAR is less often performed. Given the complexity of TAAA cases, these results may have significant implications for patient safety in the current era of heightened health care scrutiny.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>22898505</pmid><doi>10.1016/j.jtcvs.2011.10.098</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Aortic Aneurysm, Thoracic - mortality Aortic Aneurysm, Thoracic - surgery Biological and medical sciences Blood and lymphatic vessels Blood Vessel Prosthesis Implantation - adverse effects Blood Vessel Prosthesis Implantation - mortality Blood Vessel Prosthesis Implantation - trends Cardiology. Vascular system Cardiothoracic Surgery Chi-Square Distribution Databases, Factual - trends Diseases of the aorta Endovascular Procedures - adverse effects Endovascular Procedures - mortality Endovascular Procedures - trends Healthcare Disparities - trends Hospital Bed Capacity - statistics & numerical data Hospitals - trends Humans Inpatients - statistics & numerical data Medical sciences Patient Safety - statistics & numerical data Pneumology Residence Characteristics - statistics & numerical data Retrospective Studies Risk Assessment Risk Factors Time Factors Treatment Outcome United States - epidemiology |
| title | Nationwide trends and regional/hospital variations in open versus endovascular repair of thoracoabdominal aortic aneurysms |
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