National Study of Index and Readmission Mortality and Costs for Thoracic Endovascular Aortic Repair in Patients With Renal Disease

Background. In the current era of value-based health care delivery, an understanding of patient populations at greatest risk for mortality, complications, and readmissions after thoracic endovascular aortic repair (TEVAR) is warranted. Thus, the present study aimed to evaluate outcomes after TEVAR for patients with varying degrees of renal dysfunction. Methods. All patients who underwent TEVAR from 2010 to 2015 in the Nationwide Readmissions Database were identified. These patients were further stratified into four groups: no chronic kidney disease (NCKD), chronic kidney disease (CKD) stages 1 to 3 (CKD1-3), CKD 4 to 5 (CKD4-5), and end-stage renal disease (ESRD) requiring dialysis. Multivariable regression analysis was used to study index mortality, early (30 days) and intermediate (31-90 days) readmissions, costs, and length of stay. Kaplan-Meier analyses were performed to compare readmission performance among all four groups. Results. An estimated 121,046 patients underwent TEVAR with 26,653 (22.1%) being elective. Patients with ESRD comprised 2.7% of elective and 5.4% of nonelective TEVAR operations. Patients with CKD4-5 (17.8%; P = .01) and with ESRD (21.1%; P <.001), but not with CKD1-3 (14.1%; P = .12), had remarkably higher early readmission rate than the NCKD cohort (9.2%). Patients with ESRD had remarkably higher hospitalization costs than the NCKD group ($7456; 95% confidence interval, $2629-$12,283). Cardiovascular, infectious, and vascular complications were the most prevalent diagnoses on readmission, with no remarkable difference among the NCKD and CKD4-5/ESRD groups. Conclusions. Nearly 10% of all patients with TEVAR have evidence of chronic kidney disease of varying severity. Only patients with ESRD are at risk of substantially higher odds of mortality, readmissions, index length of stay, and costs compared with the non-CKD cohort. (C) 2020 by The Society of Thoracic Surgeons