The Effect of Age on Cost
and Outcomes Following
Thoracic Aortic Dissection
Matthew S. Slater, MD,
Brian S. Diggs, PhD
Frederick A. Tibayan, MD
Steven G Guyton, MD, MPH
Howard K. Song, MD, PhD
The Department of Surgery, and the Division of Cardiothoracic Surgery,
Oregon Health and Sciences University, Portland, Oregon
The Effect of Age on Cost and Outcomes Following Thoracic
Aortic Dissection
 Aortic dissection is a highly
lethal disease
 The majority of aortic
dissections, especially those
in the thoracic aorta, occur in
the elderly
 Treatment can be medical,
surgical, or endovascular
 The effect of age on
mortality, LOS and cost is
poorly defined and important
in the formulation treatment
and resource allocation
decisions
 The National Inpatient
Sample (NIS)
 Federally supported
 1 in 5 hospitalized patients
 Administrative data
 In-hospital survival
 ICD-9 disease and
procedure codes
The Effect of Age on Cost and Outcomes Following Thoracic
Aortic Dissection
NIS Dissections
26,896
 This study is a
retrospective
analysis of aortic
dissection utilizing
the NIS
 Mortality
 LOS
 Cost
 Discharge
disposition
 Analysis focussed on
thoracic dissection
Thoracic
12,916
Surgery
(“A”)
3,893
30%
No
Surgery
(“B”)
9,023
70%
Thoracoabdominal
4,178
Abdominal
7,59
“Other”
2,743
Mortality
Under 70 v. Over 70
Utilization of the National Inpatient Sample (NIS) to
Evaluate Aortic Disease
PRO: Large number of patients, cross section of the
entire country
CON: Definitions and categories of disease not ideal
Thoracic Dissections: Mortality by Age
Patient Distribution
No Surgery
Mortality
Surgery
No Surgery
Linear increase in mortality with age,
particularly with surgical intervention
No clear “age threshold”
Surgery
Thoracic Dissections: Outcomes
LOS
No Surgery
Cost
Surgery
No significant change in LOS with age
No Surgery
Surgery
No significant change in cost with age
Thoracic Dissections: Distribution of DC to Home
Percent Patients Discharged to Home by
Age and surgery / No Surgery
No Surgery
Surgery
Cost* per patient, per survivor, and per routine (to
home) discharge
Surgery and No surgery combined
*Cost per survivor is total cost for entire
cohort divided by number of survivors
Cost per patient, per survivor, and per
routine (to home) discharge
Surgery and No surgery separated
Limitations
Definitions of Dissection
Limited data fields
 NIS – “Thoracic”
 Length of follow-up
 Thoracic + Surgery=Ascending
 Thoracic – surgery= Descending
 A and B
 Ascending and Decending
 I-IV
 Quality of life evaluation
 Pre-operative risk factors
lacking, multivariate risk
analysis limited
Conclusions: Thoracic Dissection
Mortality
Cost and LOS
 There is no discreet age
 Cost and length of stay remain
above which mortality
increases dramatically, rather
the effect is linear.
 Age “cutoffs” for limiting care
for elderly patient with
thoracic dissections are
arbitrary.
constant despite increasing age for
both surgery and medical patients.
Therefore, neither cost nor LOS
are relevant reasons to limit
care in the elderly.
 Although a lower percentage of
elderly patient are discharged
home, this has not been a
traditional variable to determine
care allocation