Endovascular versus open repair of @entity397 descending thoracic aortic aneurysms: a nationwide risk-adjusted study of 923 XXXX .

@entity1 @entity8 @entity449 @entity1755 @entity397 @entity2333 @entity52901
OBJECTIVE: Recent studies support the use of endovascular treatment for @entity1755 , but few studies have examined the use of thoracic endovascular aortic repair (TEVAR) for @entity397 descending thoracic @entity449 . We evaluated nationwide data regarding short-term outcomes of TEVAR and open aortic repair ( @entity52901 ) for @entity397 descending thoracic @entity449 . METHODS: From US Nationwide Inpatient Sample data, we identified 923 @entity1 who underwent @entity397 descending thoracic @entity449 repair in 2006-2008 and who had no concomitant @entity2333 . Of these @entity1 , 364 (39.4%) underwent TEVAR and 559 (60.6%) underwent @entity52901 . Multivariable regression was used to assess the effect of TEVAR versus @entity52901 after adjusting for potential confounding factors. Outcomes assessed were in-hospital mortality, complications, failure to rescue (defined as the mortality among @entity1 in whom a complication develops), and disposition. Backward stepwise logistic regression was used to identify independent predictors of outcomes for each approach. RESULTS: @entity1 undergoing TEVAR were older (72    12 years vs 65    15 years; P < .001) and had a higher Deyo comorbidity index (4.19    1.79 vs 3.14    2.05; P < .001) than @entity1 undergoing @entity52901 . Unadjusted mortality was 23.4% (85/364) for TEVAR and 28.6% (160/559) for @entity52901 . After risk adjustment, the odds of mortality, complications, and failure to rescue were similar for @entity52901 (P > .1 for all), but @entity1 undergoing TEVAR had a greater chance of routine discharge (odds ratio [OR] = 3.3; P < .001). An interaction was identified that linked hospital size and operative approach with risk of complications (P < .001). In smaller hospitals, TEVAR was associated with lower complication rates than @entity52901 (OR = 0.21; P < .05). Regression analysis revealed that smaller hospital size predicted significantly higher rates of mortality (OR = 2.4; P < .05), complications (OR = 4.0; P < .005), and failure to rescue (OR = 51.12; P < .001) in those undergoing @entity52901 but not in those undergoing TEVAR. Preexisting @entity8 substantially increased mortality risk (OR = 10.81; P < .001) and failure to rescue (OR = 309.54; P < .001) in @entity1 undergoing TEVAR. CONCLUSIONS: Nationwide data for @entity397 descending thoracic @entity449 reveal equivalent mortality, complication rates, and failure to rescue for TEVAR and @entity52901 but more frequent routine discharge with TEVAR. Unlike @entity52901 outcomes, TEVAR outcomes were not poorer in smaller hospitals, where TEVAR produced fewer complications than @entity52901 . Therefore, TEVAR may be an ideal alternative to @entity52901 for @entity397 descending thoracic @entity449 , particularly in small hospitals where expertise in @entity52901 may be lacking and immediate transfer to a higher echelon of care may not be feasible.
