population-based analysis of outcomes after repair of thoracic aortic emergencies in trauma

Background: Large-scale assessments of outcomes in thoracic endovascular repair (TEVAR) for thoracic aortic emergencies are lacking. We evaluated perioperative outcomes of TEVAR compared with open surgery among trauma patients in a large statewide database. Materials and methods: We evaluated the California Office of Statewide Health Planning and Development 2007-2014 patient discharge database. Blunt-injured trauma patients with thoracic aortic emergencies were identified by International Classification for Diseases, Ninth Revision, Clinical Modification diagnosis codes and external cause-of-injury codes. Procedure codes were evaluated for TEVAR or open repair. Outcomes included mortality or complications during the index admission and readmission within 30 d. The association between both operative methods and each outcome was evaluated by two-level logistic regression adjusting for age, length of stay, admission year, trauma-related mortality probability, and comorbidity status. Results: Among over 31 million hospitalizations, we identified 48,357 cases (0.2%) of thoracic aortic disease. Of these, 2159 (4.5%) were unique blunt-injured trauma patients of whom 336 (15.6%) underwent operative repair: 256 TEVAR (76.2%) and 80 (23.8%) open repair. Patients with open repair were older than TEVAR patients (mean age 52.0 versus 46.8, P = 0.038). There were no significant differences in race, sex, injury mechanism, mortality, or 30-d readmission by operative method. However, open repair was associated with greater odds for cardiac, spinal cord, and neurological complications. Conclusions: Although mortality in trauma patients who underwent TEVAR was similar to that in patients with open repair, TEVAR was associated with fewer complications. This suggests that TEVAR offers clinical benefit over open repair in treating trauma patients with aortic disease. (C) 2018 Elsevier Inc. All rights reserved.