TY - JOUR
T1 - Contemporary trends in practice patterns and clinical outcomes of thoracic endovascular aortic repair for nontraumatic thoracic aortic disease in the Vascular Quality Initiative
AU - D'Oria, Mario
AU - Neal, Dan
AU - Budtz-Lilly, Jacob
AU - Cooper, Michol
AU - De Martino, Randall
AU - Mani, Kevin
AU - Lepidi, Sandro
AU - Stone, David
AU - Scali, Salvatore
PY - 2025/5
Y1 - 2025/5
N2 - Introduction: The purpose of this analysis was to document longitudinal changes in thoracic endovascular aortic repair practice patterns and clinical outcomes, using data from the Vascular Quality Initiative. Methods: All patients who underwent elective or nonelective thoracic endovascular aortic repair from 2015 to 2023 were reviewed (N = 23,532). The primary outcomes were in-hospital mortality and long-term survival. Secondary outcomes included in-hospital major complications and postoperative spinal cord ischemia. Procedures were classified into 3 time periods: early (2015–2017), middle (2018–2020), and late (2021–2023). Results: Among elective procedures, a significant trend toward an increased proportion of dissection and penetrating aortic ulcer/intramural hematoma indications being treated over time was noted. Overall crude incidence of postoperative complications decreased significantly (25% vs 23% vs 21%; P < .001). In risk-adjusted analysis, incidence of any in-hospital complication declined for elective procedures, as well as nonelective cases (odds ratio, 0.93–0.96; 95% confidence interval, 0.92–0.98; P = .002). In particular, risk of spinal cord ischemia decreased after elective procedures (odds ratio, 0.96; 0.92–0.99; P = .03) but showed no change for nonelective cases despite an overall decrease in preoperative spinal drain use (41% vs 33% vs 23%; P < .001). Overall, unadjusted rates of in-hospital death did not vary significantly between time periods (5.8% vs 5.4% vs 5.4%; P = .45). However, in risk-adjusted analysis, in-hospital mortality risk decreased longitudinally after elective surgery (odds ratio, 0.94; 0.9–0.98; P = .001) but not for nonelective cases (P = .13). Cox regression analysis showed improved long-term survival for elective cases (hazard ratio, 0.96; 0.94–0.99; P = .02) but no change for nonelective procedures. Conclusion: This analysis offers contemporary insights into thoracic endovascular aortic repair practice patterns and clinical outcomes, providing valuable benchmarking information for stakeholders focused on enhancing care delivery for this complex patient population.
AB - Introduction: The purpose of this analysis was to document longitudinal changes in thoracic endovascular aortic repair practice patterns and clinical outcomes, using data from the Vascular Quality Initiative. Methods: All patients who underwent elective or nonelective thoracic endovascular aortic repair from 2015 to 2023 were reviewed (N = 23,532). The primary outcomes were in-hospital mortality and long-term survival. Secondary outcomes included in-hospital major complications and postoperative spinal cord ischemia. Procedures were classified into 3 time periods: early (2015–2017), middle (2018–2020), and late (2021–2023). Results: Among elective procedures, a significant trend toward an increased proportion of dissection and penetrating aortic ulcer/intramural hematoma indications being treated over time was noted. Overall crude incidence of postoperative complications decreased significantly (25% vs 23% vs 21%; P < .001). In risk-adjusted analysis, incidence of any in-hospital complication declined for elective procedures, as well as nonelective cases (odds ratio, 0.93–0.96; 95% confidence interval, 0.92–0.98; P = .002). In particular, risk of spinal cord ischemia decreased after elective procedures (odds ratio, 0.96; 0.92–0.99; P = .03) but showed no change for nonelective cases despite an overall decrease in preoperative spinal drain use (41% vs 33% vs 23%; P < .001). Overall, unadjusted rates of in-hospital death did not vary significantly between time periods (5.8% vs 5.4% vs 5.4%; P = .45). However, in risk-adjusted analysis, in-hospital mortality risk decreased longitudinally after elective surgery (odds ratio, 0.94; 0.9–0.98; P = .001) but not for nonelective cases (P = .13). Cox regression analysis showed improved long-term survival for elective cases (hazard ratio, 0.96; 0.94–0.99; P = .02) but no change for nonelective procedures. Conclusion: This analysis offers contemporary insights into thoracic endovascular aortic repair practice patterns and clinical outcomes, providing valuable benchmarking information for stakeholders focused on enhancing care delivery for this complex patient population.
UR - http://www.scopus.com/inward/record.url?scp=85216764950&partnerID=8YFLogxK
U2 - 10.1016/j.surg.2025.109153
DO - 10.1016/j.surg.2025.109153
M3 - Journal article
C2 - 39908703
AN - SCOPUS:85216764950
SN - 0039-6060
VL - 181
JO - Surgery
JF - Surgery
M1 - 109153
ER -