Thoracic Aortic Aneurysm Patients’ Diagnosis, Treatments, and Outcomes: The New York Experience

Authors

Ashutosh Yaligar, State University of New York at Stony BrookFollow
Annet Kuruvilla, State University of New York at Stony BrookFollow
Joshua Helali, Scripps Clinic/Scripps Green HospitalFollow
Junying Wang, State University of New York at Stony BrookFollow
Mohammad Noubani, State University of New York at Stony BrookFollow
Sohaib Agha, New York Institute of TechnologyFollow
Daniel Wolbrom, State University of New York at Stony BrookFollow
Jie Yang, State University of New York at Stony BrookFollow
Jonathan Price, State University of New York at Stony BrookFollow
Thomas Bilfinger, State University of New York at Stony BrookFollow
Henry Tannous, State University of New York at Stony BrookFollow
Annie-Laurie Shroyer, State University of New York at Stony BrookFollow
Allison McLarty, State University of New York at Stony BrookFollow

Document Type

Report

Publication Date

12-12-2022

Keywords

Cardiac Surgery, Thoracic Aortic Aneurysm, Incidence Rate, Treatment Rate, NYS SPARCS

Abstract

IMPORTANCE: Traditionally, thoracic aortic aneurysms (TAA) were diagnosed upon complications arising or post-mortem examination. Following 2014, asymptomatic new TAA diagnoses noticeably rose at increasing rates. In parallel, reductions in the rates of urgent/emergent TAA-related treatments and adverse risk-adjusted short-term outcomes were observed.

OBJECTIVES: For New York State adult residents, the trends from 2005 to 2018 in new thoracic aortic aneurysm (TAA) diagnoses, surgical treatments, percutaneous treatments, and risk-adjusted outcomes were examined.

DESIGN: This retrospective cohort study documented the quality of TAA care provided to New York adult residents.

SETTING: Using the 2005 to 2018 New York Statewide Planning and Research Cooperative System (SPARCS) database, billing codes detected 74,118 newly diagnosed TAA patients; of these, 84.06% (n = 62,307) were non-ruptured diagnoses.

PARTICIPANTS: Overall, TAA patients’ mean age was 71.00 years + 19.00 years; 62.47% were male.

EXPOSURES: TAA patients’ baseline characteristics, TAA-related interventions, and adverse outcomes were reported.

MAIN OUTCOMES: Trends over time were evaluated for TAA diagnosis rates, TAA surgical and percutaneous treatment rates, and adverse clinical outcomes (e.g., 30-day mortality, and 30-day readmission).

RESULTS: Overall, new TAA diagnoses increased from 19.8/100,000 residents (2005) to 75.73/100,000 residents (2018); starting in 2014, a dramatic rise in detection of new non-ruptured TAA diagnoses was observed. In contrast, treatment rates decreased for surgical (19.33% in 2005 to 6.54% in 2018) and percutaneous (4.17% in 2006 to 1.53% in 2018) procedures. Comparing pre-2014 versus post-2014, TAA patients had greater chances of having an open surgery (odds ratio [OR] = 1.77; p < 0.0001) or percutaneous procedure (OR = 1.79; p < 0.0001). Over time, 30-day operative mortality decreased (OR = 0.94; p-value < 0.0001). As an “at risk” patient sub-group, however, elderly women had very high 30-day mortality risk (OR: 1.87; p < 0.0001).

CONCLUSIONS: Post-2014, the New York State rates of new non-rupture TAA diagnoses radically increased; serendipitously, the TAA-related treatment and short-term adverse outcome rates decreased. Given expanded chest imaging due (in part) to new lung cancer guidelines and transcatheter aortic valve procedures, the enhanced TAA diagnosis rates post-2014 appear to have resulted in overall TAA patients’ quality of care improvements.

Recommended Citation

Yaligar, Ashutosh; Kuruvilla, Annet; Helali, Joshua; Wang, Junying; Noubani, Mohammad; Agha, Sohaib; Wolbrom, Daniel; Yang, Jie; Price, Jonathan; Bilfinger, Thomas; Tannous, Henry; Shroyer, Annie-Laurie; and McLarty, Allison, "Thoracic Aortic Aneurysm Patients’ Diagnosis, Treatments, and Outcomes: The New York Experience" (2022). Department of Surgery Faculty Publications. 5.
https://commons.library.stonybrook.edu/dos-articles/5