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. 2011 Jun;53(6):1499-505.
doi: 10.1016/j.jvs.2011.02.014.

National trends and regional variation of open and endovascular repair of thoracic and thoracoabdominal aneurysms in contemporary practice

Salvatore T Scali  1 , Philip P Goodney, Daniel B Walsh, Lori L Travis, Brian W Nolan, David C Goodman, F Lee Lucas, David H Stone
Affiliations

National trends and regional variation of open and endovascular repair of thoracic and thoracoabdominal aneurysms in contemporary practice

Salvatore T Scali et al. J Vasc Surg. 2011 Jun.

Abstract

Objectives: Successful surgical management of thoracic aortic aneurysms (TAA) and thoracoabdominal aortic aneurysms (TAAA) has historically relied upon open surgical repair (OSR). More recently, the advent and application of thoracic endovascular stent graft aneurysm repair (TEVAR) permutations have become increasingly performed in contemporary practice. To better determine the effect of TEVAR techniques on OSR, we examined national and regional trends in treatment use.

Methods: All Medicare patients from 1998 through 2007 undergoing isolated TAA and TAAA repair were analyzed using a clinically validated algorithm using diagnostic International Classification of Disease 9th revision (ICD-9; 441.1, 441.2, 441.6, 441.7, 441.9) codes and procedural (ICD-9 OSR: 38.35, 38.45 and TEVAR: 39.73, 39.79) codes. Differential rates of OSR and TEVAR were compared across census tract regions during the study interval.

Results: Total complex aortic repairs increased by 60%, from 10.8 to 17.8/100,000, between 1998 and 2007 (P < .001). A dramatic increase occurred in TEVAR (not performed in 1998, 5.8/100,000 in 2007) during the study period, but OSR rates remained stable during the same interval (10.7 to 12.0/100,000 in 2007, P = NS). There was substantial regional variation for both OSR and TEVAR. This regional variation was greater in OSR (range, 8.8-16.7/100,000) than in TEVAR (range, 4.5-6.9/100,000).

Conclusions: Degenerative TAA and TAAA aneurysms are being repaired in the United States at an increasing rate. This reflects the rapid acceptance of TEVAR, which apparently supplements rather than supplants OSR. There appears to be greater regional variation in OSR compared with TEVAR. These data may have significant implications for those interested in the effect of new technologies on health care and cost containment.

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Figures

Fig. 1
Fig. 1
International Classification of Diseases, 9th edition and Current Procedural Terminology coding strategy for thoracic aortic aneurysms (TAA) and thoracoabdominal aortic aneurysms (TAAA) TEVAR, Thoracic endovascular aortic aneurysm repair.
Fig. 2
Fig. 2
Map shows the nine census tract regions of the United States, as designated by the U.S. Census Bureau. Adapted from http://www.census.gov/factsheet.
Fig. 3
Fig. 3
Rates of total thoracic and thoracoabdominal aortic aneurysm repair (diamonds), open repair (squares) and endovascular repair (triangles) in Medicare patients, 1998–2007. CI, Confidence interval.
Fig. 4
Fig. 4
Regional variation in use of open and endovascular repair of thoracic and thoracoabdominal aneurysms (TEVAR) among Medicare beneficiaries in 2007.
See this image and copyright information in PMC

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