Abstract 12162: Trends of Thoracic Endovascular Repair of Aortic Dissection among Medicare Beneficiaries, 2005-2010
Background: Thoracic endovascular aortic repair (TEVAR) has emerged as an effective alternative to open surgical repair for the management of complicated distal aortic dissection. Data on its adoption as well as long-term outcomes of this procedure, especially among older patients, are scarce. Accordingly, we analyzed national Medicare data to determine use of and outcomes after TEVAR from 2005 to 2010.
Methods: Inpatient Medicare standard analytic files were used to identify 100% of fee-for-service (FFS) patients aged ≥65 years who had a primary discharge diagnosis of aortic dissection (ICD-9-CM codes 441.01 or 441.03) and who underwent TEVAR (ICD-9-CM procedure code 39.73) from 2005 to 2010. We linked inpatient data with the Medicare denominator file to report operative rates per 1 million person-years. Thirty-day and 1-year mortality rates as well as 30-day readmission rates were ascertained through corresponding vital status and inpatient files.
Results: A total of 1,577 TEVAR procedures were performed during 2005-2010 among Medicare FFS beneficiaries. The overall procedure rate for TEVAR increased from 1 per million person-years (n=42 procedures) in 2005 to 13 per million person-years (n=368 procedures) in 2010. Rates of TEVAR increased across all age, sex and race subgroups through the study period, with consistently higher rates among those aged 75-84 years, men and blacks. Length of stay remained stable at ~10 days. From 2005 to 2010, the 30-day mortality rate increased from 9.5% (95% CI, 2.6%-22.6%) to 11.8% (95% CI, 8.6%-15.6%), and the 1-year mortality rate increased from 16.7% (95% CI, 7.0%-31.4%) to 23.4% (95% CI, 19.1%-28.0%). The 30-day readmission rate increased from 15.0% (95% CI, 5.7%-29.8%) in 2005 to 22.3% (95% CI, 17.9%-27.3%) in 2010.
Conclusion: This is the first national study to present data on the adoption of and outcomes after TEVAR among an elderly population. Utilization of TEVAR in patients with aortic dissection has increased notably in recent years, even among older patients. However, the increasing trend in long-term mortality and readmission rates should be the focus of further investigation and could represent changes in patient selection or worsening performance.
- © 2012 by American Heart Association, Inc.