TY - JOUR
T1 - Aortic Surgery Outcomes of Marfan Syndrome and Ehlers-Danlos Syndrome Patients at Teaching and Nonteaching Hospitals
AU - Holscher, Courtenay M.
AU - Dakour Aridi, Hanaa
AU - Locham, Satinderjit S.
AU - Hicks, Caitlin W.
AU - Canner, Joseph K.
AU - Malas, Mahmoud
AU - Black, James H.
N1 - Funding Information:
We conducted a retrospective review of data from the National Inpatient Sample (NIS). The NIS is provided through the United States federal government by the Agency for Healthcare Research and Quality (AHRQ) as part of the Healthcare Cost and Utilization Project (HCUP), which is a partnership of state databases, hospital organizations, private data organizations, and the federal government. The HCUP administrates several databases, including the NIS, for the purpose of research to inform decision-making and support improvement in health-care delivery. The NIS is a 20% stratified sample of all discharges from community hospitals in the United States and serves as the largest all-payer inpatient hospitalization database.17 The NIS is sampled from states participating in the HCUP, includes unweighted data on 7 million hospitalizations yearly, and represents more than 96% of the US population.17 This study was acknowledged by the Johns Hopkins Medicine Institutional Review Board (IRB00072644). Informed consent was waived as the data were derived from a deidentified, publicly available database.Our primary outcome was in-hospital mortality as reported in the NIS. Secondary outcomes included in-hospital complications, length of stay, discharge disposition, and total hospital charges. Total charges as reported in the NIS do not include professional fees and noncovered charges, which include items such as television and phone charges.17 International Classification of Diseases, 9th Revision codes were used to determine in-hospital complications as well as patient comorbid diseases. Patients? comorbidities were classified using the Charlson Comorbidity Index.18 Complications were categorized by organ system as cardiac, pulmonary, renal, neurologic, gastrointestinal, wound/infectious/septic, and hemorrhage/transfusion; specific International Classification of Diseases, 9th Revision codes are included in Supplemental Table I.
Funding Information:
Our primary outcome was in-hospital mortality as reported in the NIS. Secondary outcomes included in-hospital complications, length of stay, discharge disposition, and total hospital charges. Total charges as reported in the NIS do not include professional fees and noncovered charges, which include items such as television and phone charges.17 International Classification of Diseases, 9th Revision codes were used to determine in-hospital complications as well as patient comorbid diseases. Patients' comorbidities were classified using the Charlson Comorbidity Index.18 Complications were categorized by organ system as cardiac, pulmonary, renal, neurologic, gastrointestinal, wound/infectious/septic, and hemorrhage/transfusion; specific International Classification of Diseases, 9th Revision codes are included in Supplemental Table I.
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2019/2
Y1 - 2019/2
N2 - Background: Despite improvements in prevention and management, aortic aneurysm repair remains a high-risk operation for patients with Marfan syndrome (MFS) and Ehlers-Danlos syndrome (EDS). The goal of this study was to examine differences in characteristics and outcomes of patients with MFS or EDS undergoing aortic aneurysm repair at teaching versus nonteaching hospitals. Methods: We used the National Inpatient Sample to study patients with MFS or EDS undergoing open or endovascular aortic aneurysm repair from 2000 to 2014. Results: Of 3487 patients (MFS = 3375, EDS = 112), 2974 (85%) had repair at a teaching hospital. Patients who underwent repair at a teaching hospital were slightly younger than those who underwent repair at a nonteaching hospital (38 vs. 43 years, P < 0.01) but otherwise were similar in gender (29% vs. 28% female), race (70% vs. 78% white), and connective tissue disorder diagnosis (97% vs. 97% MFS, all P ≥ 0.1). There were no differences in anatomy (17% vs. 19% abdominal, 67% vs. 66% thoracic, and 15% vs. 15% thoracoabdominal, all P ≥ 0.1) or type of repair (5% vs. 5% endovascular), but patients at nonteaching hospitals were more likely to have a dissection (49% vs. 38%, P = 0.02). There was no difference in perioperative mortality (4% vs. 6%, P = 0.5) or length of stay (median 8 days vs. 7 days, P = 0.3) between teaching and nonteaching hospitals. There was also no difference in hemorrhagic (47% vs. 43%), pulmonary (9% vs. 16%), renal (12% vs. 14%), or neurologic (5% vs. 6%) complications between teaching and nonteaching hospitals, respectively (all P ≥ 0.05). In analysis stratified by anatomic extent of repair, there was a lower prevalence of pulmonary complications in thoracic aorta repairs at teaching hospitals (8.1% vs. 18.4%, P = 0.01) but a higher prevalence of hemorrhage in abdominal aortic repairs at teaching hospitals (45.6% vs. 20.6%, P = 0.04) as compared with nonteaching hospitals. Conclusions: Patients with MFS and EDS who undergo aortic aneurysm repair have their operations predominantly at teaching hospitals, but those patients who undergo repair at nonteaching hospitals do not have worse mortality or morbidity despite a higher incidence of dissection.
AB - Background: Despite improvements in prevention and management, aortic aneurysm repair remains a high-risk operation for patients with Marfan syndrome (MFS) and Ehlers-Danlos syndrome (EDS). The goal of this study was to examine differences in characteristics and outcomes of patients with MFS or EDS undergoing aortic aneurysm repair at teaching versus nonteaching hospitals. Methods: We used the National Inpatient Sample to study patients with MFS or EDS undergoing open or endovascular aortic aneurysm repair from 2000 to 2014. Results: Of 3487 patients (MFS = 3375, EDS = 112), 2974 (85%) had repair at a teaching hospital. Patients who underwent repair at a teaching hospital were slightly younger than those who underwent repair at a nonteaching hospital (38 vs. 43 years, P < 0.01) but otherwise were similar in gender (29% vs. 28% female), race (70% vs. 78% white), and connective tissue disorder diagnosis (97% vs. 97% MFS, all P ≥ 0.1). There were no differences in anatomy (17% vs. 19% abdominal, 67% vs. 66% thoracic, and 15% vs. 15% thoracoabdominal, all P ≥ 0.1) or type of repair (5% vs. 5% endovascular), but patients at nonteaching hospitals were more likely to have a dissection (49% vs. 38%, P = 0.02). There was no difference in perioperative mortality (4% vs. 6%, P = 0.5) or length of stay (median 8 days vs. 7 days, P = 0.3) between teaching and nonteaching hospitals. There was also no difference in hemorrhagic (47% vs. 43%), pulmonary (9% vs. 16%), renal (12% vs. 14%), or neurologic (5% vs. 6%) complications between teaching and nonteaching hospitals, respectively (all P ≥ 0.05). In analysis stratified by anatomic extent of repair, there was a lower prevalence of pulmonary complications in thoracic aorta repairs at teaching hospitals (8.1% vs. 18.4%, P = 0.01) but a higher prevalence of hemorrhage in abdominal aortic repairs at teaching hospitals (45.6% vs. 20.6%, P = 0.04) as compared with nonteaching hospitals. Conclusions: Patients with MFS and EDS who undergo aortic aneurysm repair have their operations predominantly at teaching hospitals, but those patients who undergo repair at nonteaching hospitals do not have worse mortality or morbidity despite a higher incidence of dissection.
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U2 - 10.1016/j.avsg.2018.07.052
DO - 10.1016/j.avsg.2018.07.052
M3 - Article
C2 - 30287287
AN - SCOPUS:85054577664
SN - 0890-5096
VL - 55
SP - 175-181.e3
JO - Annals of Vascular Surgery
JF - Annals of Vascular Surgery
ER -