BLUNT THORACIC AORTIC INJURY MANAGEMENT IN A NATIONAL INPATIENT SAMPLE
George Philip, MD., Brett Aplin, MD., Faisal Khateeb MD, Weikai Qu, MD, PhD., Jihad Abbas, MD.,
Hammed Amer, MD., Gerald Zelenock MD., Munier Nazzal, MD
Objective: To determine the hospital outcomes of endovascular (TEVAR) and open (OPEN) interventions of thoracic aorta injuries (TAI) by analyzing the data of patients with TAI in Nationwide Inpatient Sample (NIS)
database[1-4].
Methods: An analysis of approximately 2988 hospital admissions from 2008-2010 was obtained from the NIS database. NIS database is part of the Healthcare Cost and Utilization Project (HCUP) sponsored by the Agency for
Healthcare Research and Quality (AHRQ). In this study we compare the 2 different treatment modalities for blunt thoracic aortic injury and compared length of stay, cost, postoperative mortality and morbidity rates. We used the
ICD-9 coding system to extract information of the demographics, comorbidities, surgical interventions and early outcomes of the treatment for TAI patients from the NIS database (2008 -2010). The data was analyzed with SPSS
Statistics v19. P<0.05 was considered statistically significant.
Results: Total number of patients with TAI was 3615 (2526 males) in 3 years. Average age of the patients was
43.4

19.7 years. Of the individuals who suffered blunt aortic injury 1746(58.4%) cases were treated by surgical intervention. In cases that were managed surgically, TEVAR was used in 1453(83%) opposed to OPEN in
288(8.1%). There was a steady increase in proportion of TAI repair done by ENDO over the three-year period
(78.6/21.4, 82.2/17.8 and 87.7/12.3 from 2008- 2010 respectfully). Chest wall fracture was present in 51.5% , 16.4% had internal injuries of thorax/abdomen/pelvis and 3.5% had head injuries. Hypertension and Diabetes were found in
20.1% and 5.6% of the patients, respectively. As indicated in table 1, mortality, ARF, cardiac complications, postoperative hemorrhage, pulmonary insufficiency and paraplegia rates were higher in open surgery.
Mean Age (mean  SD)
LOS (days, mean  SD)
Total Charge (1,000 US$, Mean  SD)
All surgery
41.7
 18.3
19.5
 20.6
Endovascular
42.4
 18.4
19.7
 21.2
Open
38.0
 17.5
18.6
 17.2
P
0.000
0.310
294.9
 255.2 300.3
 266.2 267.6
 188.7 0.014
Postoperative hemorrhage(%)
Mortality rate (n/%)
Paraplegia (%)
Postoperative Stroke (%)
Myocardial Infarction (%)
Renal Failure (%)
Pulmonary Insufficiency (%)
Cardiac complications (%)
Postoperative Infection (%)
3.9
140/8.1
0.5
1.2
1.2
0.2
31.7
1.7
1.7
0.7
111/7.7
0.3
1.1
1.0
0
29.8
1.0
1.7
3.2
29/10.1
1.4
1.7
1.7
1.4
41.7
4.9
1.7
Conclusions: Majority of the TAI patients in USA who underwent surgical intervention were treated endovascularly in recent years. The data supports endovascular repair may reduce mortality and complications rates but is found to be more expensive.
0.016
0.177
0.047
0.374
0.358
0.001
0.000
0.000
0.997

References
1.
2.
3.
4.
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