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. 2022 Jun 24:38:16.
doi: 10.5758/vsi.220007.

Contemporary Unplanned Readmission Trends Following Management of Type B Aortic Dissection

Ashley J Williamson  1 , Seth Sankary  1 , Kristine Marie Kuchta  2 , Sara Gaines  1 , Omar Morcos  2 , Benjamin Lind  2 , Luka Pocivavsek  1 , Anahita Dua  3 , Cheong J Lee  2
Affiliations

Contemporary Unplanned Readmission Trends Following Management of Type B Aortic Dissection

Ashley J Williamson et al. Vasc Specialist Int. .

Abstract

Purpose: Large studies have demonstrated improved survival outcomes with thoracic endovascular aortic repair (TEVAR) at two and five years compared to medical therapy; however, early TEVAR for acute type B aortic dissection (TBAD) remains controversial. We aimed to evaluate trends and clinical predictors of hospital readmissions in patients undergoing medical management and TEVAR for acute TBADs.

Materials and methods: The Nationwide Readmissions Database was queried for all 30-day and 90-day index readmissions (30D-IR and 90D-IR, respectively) after a diagnosis of a TBAD from January 2012 to September 2015. Data on readmission diagnosis, patient demographics, and hospital characteristics were collected from readmitted patients and analyzed. Multivariable logistic regression models were used to identify the predictors of readmission after TEVAR or medical medical management of TBAD.

Results: We identified 53,117 patients with acute TBAD. Medical management was the initial treatment modality in 46,985 (88.4%) patients, while 6,132 (11.5%) underwent TEVAR. Factors including older patient age, lower household income, severity of comorbidities, initial hospital length of stay, and urgent procedure demonstrated an increased likelihood of experiencing 30D-IR and 90D-IR (P<0.05). The rate of unplanned readmission for patients undergoing medical management remained stable (11.3% vs. 10.0% for 30D-IR; 19.1% vs. 15.5% for 90D-IR). Reasons for unplanned readmission in the TEVAR cohort were largely related to technical complications. There was no significant difference in readmission costs between medical management and TEVAR.

Conclusion: Number of unplanned readmissions in the TEVAR arm decreased significantly over time, whereas the number of readmissions for medical management remained stable.

Keywords: Aortic dissection; Nationwide readmissions database; Readmission; Thoracic endovascular aortic repair; Type B dissection.

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Conflict of interest statement

CONFLICTS OF INTEREST

The authors have nothing to disclose.

Figures

Fig. 1
Fig. 1
Patient selection, exclusion criteria, and final cohort chosen for analysis between thoracic endovascular aortic repair (TEVAR) and medical management.
Fig. 2
Fig. 2
Readmissions trends following management of type B aortic dissections. As the number of thoracic endovascular aortic repair (TEVAR) procedures performed increased, the percentage of readmissions significantly decreased over time. The percentage of medical management readmissions remained stable throughout the study.
See this image and copyright information in PMC

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