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


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.

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