Ruptured thoracoabdominal aortic aneurysm treatment in the United States: 1988 to 1998
Thoracoabdominal aortic aneurysm (TAAA) rupture usually results in death. The outcome remains poor for patients who reach the operating room. The objective of this investigation was to define contemporary surgical experience with ruptured TAAA in the United States. Clinical data derived from the Nat...
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Veröffentlicht in: | Journal of vascular surgery 2003-08, Vol.38 (2), p.319-322 |
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creator | Cowan, John A Dimick, Justin B Wainess, Reid M Henke, Peter K Stanley, James C Upchurch, Gilbert R |
description | Thoracoabdominal aortic aneurysm (TAAA) rupture usually results in death. The outcome remains poor for patients who reach the operating room. The objective of this investigation was to define contemporary surgical experience with ruptured TAAA in the United States.
Clinical data derived from the Nationwide Inpatient Sample on patients who underwent repair of a ruptured TAAA from 1988 to 1998 were analyzed. Age, sex, race, nature of admission, comorbid conditions, and provider volume were abstracted from the database. In-hospital mortality, postoperative complications, and length of stay were the principal outcome measures.
Three hundred twenty-one patients were identified for the study. Mean age was 71.5 years; men outnumbered women (63% vs 37%). Crude overall surgical mortality was 53.8% and did not improve over time. Operative mortality was most likely (51%) to occur within the first 24 hours postoperatively. Median length of stay for surviving patients was 16 days. Renal failure (28%) and cardiac complications (18%) were the most common complications. In a logistic regression model, age greater than 77 years was predictive of death (odds ratio [OR], 2.5;
P = .005), and nonwhite race appeared protective (OR, 0.53;
P = .013).
Mortality after surgical treatment of ruptured TAAA is high. Surviving patients experience many postoperative complications and have lengthy hospital stays. Given the lack of significant improvement in contemporary surgical practice, new techniques of repair deserve the attention of clinicians. |
doi_str_mv | 10.1016/S0741-5214(03)00227-1 |
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Clinical data derived from the Nationwide Inpatient Sample on patients who underwent repair of a ruptured TAAA from 1988 to 1998 were analyzed. Age, sex, race, nature of admission, comorbid conditions, and provider volume were abstracted from the database. In-hospital mortality, postoperative complications, and length of stay were the principal outcome measures.
Three hundred twenty-one patients were identified for the study. Mean age was 71.5 years; men outnumbered women (63% vs 37%). Crude overall surgical mortality was 53.8% and did not improve over time. Operative mortality was most likely (51%) to occur within the first 24 hours postoperatively. Median length of stay for surviving patients was 16 days. Renal failure (28%) and cardiac complications (18%) were the most common complications. In a logistic regression model, age greater than 77 years was predictive of death (odds ratio [OR], 2.5;
P = .005), and nonwhite race appeared protective (OR, 0.53;
P = .013).
Mortality after surgical treatment of ruptured TAAA is high. Surviving patients experience many postoperative complications and have lengthy hospital stays. Given the lack of significant improvement in contemporary surgical practice, new techniques of repair deserve the attention of clinicians.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/S0741-5214(03)00227-1</identifier><identifier>PMID: 12891114</identifier><identifier>CODEN: JVSUES</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal - mortality ; Aortic Aneurysm, Abdominal - surgery ; Aortic Aneurysm, Thoracic - mortality ; Aortic Aneurysm, Thoracic - surgery ; Aortic Rupture - mortality ; Aortic Rupture - surgery ; Biological and medical sciences ; Female ; Humans ; Male ; Medical sciences ; Middle Aged ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Treatment Outcome ; United States - epidemiology ; Vascular Surgical Procedures - methods</subject><ispartof>Journal of vascular surgery, 2003-08, Vol.38 (2), p.319-322</ispartof><rights>2003 The Society for Vascular Surgery and The American Association for Vascular Surgery</rights><rights>2004 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c556t-100c22ff0f551dc13d9775b938d73bef787255afba0cc9a83d50bd4e3eb490513</citedby><cites>FETCH-LOGICAL-c556t-100c22ff0f551dc13d9775b938d73bef787255afba0cc9a83d50bd4e3eb490513</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S0741-5214(03)00227-1$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15007991$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12891114$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cowan, John A</creatorcontrib><creatorcontrib>Dimick, Justin B</creatorcontrib><creatorcontrib>Wainess, Reid M</creatorcontrib><creatorcontrib>Henke, Peter K</creatorcontrib><creatorcontrib>Stanley, James C</creatorcontrib><creatorcontrib>Upchurch, Gilbert R</creatorcontrib><title>Ruptured thoracoabdominal aortic aneurysm treatment in the United States: 1988 to 1998</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Thoracoabdominal aortic aneurysm (TAAA) rupture usually results in death. The outcome remains poor for patients who reach the operating room. The objective of this investigation was to define contemporary surgical experience with ruptured TAAA in the United States.
Clinical data derived from the Nationwide Inpatient Sample on patients who underwent repair of a ruptured TAAA from 1988 to 1998 were analyzed. Age, sex, race, nature of admission, comorbid conditions, and provider volume were abstracted from the database. In-hospital mortality, postoperative complications, and length of stay were the principal outcome measures.
Three hundred twenty-one patients were identified for the study. Mean age was 71.5 years; men outnumbered women (63% vs 37%). Crude overall surgical mortality was 53.8% and did not improve over time. Operative mortality was most likely (51%) to occur within the first 24 hours postoperatively. Median length of stay for surviving patients was 16 days. Renal failure (28%) and cardiac complications (18%) were the most common complications. In a logistic regression model, age greater than 77 years was predictive of death (odds ratio [OR], 2.5;
P = .005), and nonwhite race appeared protective (OR, 0.53;
P = .013).
Mortality after surgical treatment of ruptured TAAA is high. Surviving patients experience many postoperative complications and have lengthy hospital stays. Given the lack of significant improvement in contemporary surgical practice, new techniques of repair deserve the attention of clinicians.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aortic Aneurysm, Abdominal - mortality</subject><subject>Aortic Aneurysm, Abdominal - surgery</subject><subject>Aortic Aneurysm, Thoracic - mortality</subject><subject>Aortic Aneurysm, Thoracic - surgery</subject><subject>Aortic Rupture - mortality</subject><subject>Aortic Rupture - surgery</subject><subject>Biological and medical sciences</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>Treatment Outcome</subject><subject>United States - epidemiology</subject><subject>Vascular Surgical Procedures - methods</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkEFv1DAQha2Kql0KPwGUC4geUmbieG1zQaiitFKlSpRytRx7Ilwl8dZ2KvXfk-2u6JHTXL557-lj7B3CGQKuP9-CbLEWDbafgJ8CNI2s8YCtELSs1wr0K7b6hxyz1znfAyAKJY_YMTZKI2K7Yr9_zpsyJ_JV-ROTddF2Po5hskNlYyrBVXaiOT3lsSqJbBlpKlWYFpqquymU5fG22EL5S4VaqarE5Wr1hh32dsj0dn9P2N3F91_nl_X1zY-r82_XtRNiXWoEcE3T99ALgd4h91pK0WmuvOQd9VLJRgjbdxac01ZxL6DzLXHqWg0C-Qn7uMvdpPgwUy5mDNnRMCyr45yN5IJjo_kCih3oUsw5UW82KYw2PRkEsxVqnoWarS0D3DwLNduC9_uCuRvJv3ztDS7Ahz1gs7NDn-zkQn7hBIDUehv0dcfRouMxUDLZBZoc-ZDIFeNj-M-Uv6bRkO0</recordid><startdate>20030801</startdate><enddate>20030801</enddate><creator>Cowan, John A</creator><creator>Dimick, Justin B</creator><creator>Wainess, Reid M</creator><creator>Henke, Peter K</creator><creator>Stanley, James C</creator><creator>Upchurch, Gilbert R</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>20030801</creationdate><title>Ruptured thoracoabdominal aortic aneurysm treatment in the United States: 1988 to 1998</title><author>Cowan, John A ; Dimick, Justin B ; Wainess, Reid M ; Henke, Peter K ; Stanley, James C ; Upchurch, Gilbert R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c556t-100c22ff0f551dc13d9775b938d73bef787255afba0cc9a83d50bd4e3eb490513</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic Aneurysm, Abdominal - mortality</topic><topic>Aortic Aneurysm, Abdominal - surgery</topic><topic>Aortic Aneurysm, Thoracic - mortality</topic><topic>Aortic Aneurysm, Thoracic - surgery</topic><topic>Aortic Rupture - mortality</topic><topic>Aortic Rupture - surgery</topic><topic>Biological and medical sciences</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><topic>Treatment Outcome</topic><topic>United States - epidemiology</topic><topic>Vascular Surgical Procedures - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cowan, John A</creatorcontrib><creatorcontrib>Dimick, Justin B</creatorcontrib><creatorcontrib>Wainess, Reid M</creatorcontrib><creatorcontrib>Henke, Peter K</creatorcontrib><creatorcontrib>Stanley, James C</creatorcontrib><creatorcontrib>Upchurch, Gilbert R</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>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cowan, John A</au><au>Dimick, Justin B</au><au>Wainess, Reid M</au><au>Henke, Peter K</au><au>Stanley, James C</au><au>Upchurch, Gilbert R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ruptured thoracoabdominal aortic aneurysm treatment in the United States: 1988 to 1998</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2003-08-01</date><risdate>2003</risdate><volume>38</volume><issue>2</issue><spage>319</spage><epage>322</epage><pages>319-322</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><coden>JVSUES</coden><abstract>Thoracoabdominal aortic aneurysm (TAAA) rupture usually results in death. The outcome remains poor for patients who reach the operating room. The objective of this investigation was to define contemporary surgical experience with ruptured TAAA in the United States.
Clinical data derived from the Nationwide Inpatient Sample on patients who underwent repair of a ruptured TAAA from 1988 to 1998 were analyzed. Age, sex, race, nature of admission, comorbid conditions, and provider volume were abstracted from the database. In-hospital mortality, postoperative complications, and length of stay were the principal outcome measures.
Three hundred twenty-one patients were identified for the study. Mean age was 71.5 years; men outnumbered women (63% vs 37%). Crude overall surgical mortality was 53.8% and did not improve over time. Operative mortality was most likely (51%) to occur within the first 24 hours postoperatively. Median length of stay for surviving patients was 16 days. Renal failure (28%) and cardiac complications (18%) were the most common complications. In a logistic regression model, age greater than 77 years was predictive of death (odds ratio [OR], 2.5;
P = .005), and nonwhite race appeared protective (OR, 0.53;
P = .013).
Mortality after surgical treatment of ruptured TAAA is high. Surviving patients experience many postoperative complications and have lengthy hospital stays. Given the lack of significant improvement in contemporary surgical practice, new techniques of repair deserve the attention of clinicians.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>12891114</pmid><doi>10.1016/S0741-5214(03)00227-1</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Adult Aged Aged, 80 and over Aortic Aneurysm, Abdominal - mortality Aortic Aneurysm, Abdominal - surgery Aortic Aneurysm, Thoracic - mortality Aortic Aneurysm, Thoracic - surgery Aortic Rupture - mortality Aortic Rupture - surgery Biological and medical sciences Female Humans Male Medical sciences Middle Aged Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Treatment Outcome United States - epidemiology Vascular Surgical Procedures - methods |
title | Ruptured thoracoabdominal aortic aneurysm treatment in the United States: 1988 to 1998 |
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