Incidence and characteristics of hospitalization for proximal aortic surgery for acute syndromes and for aneurysms in the USA from 2005 to 2014
Incidence and characteristics of hospitalization for proximal aortic surgery for acute syndromes and for aneurysms in the USA from 2005 to 2014
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DOI：
10.1093/ejcts/ezaa067
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发表时间：
2020-09-01
影响因子：
3.4
通讯作者：
Geirsson, Arnar
中科院分区：
文献类型：
--
作者：
Mullan, Clancy William;Mori, Makoto;Geirsson, Arnar
目的：近端胸主动脉瘤（TAA）手术在预防急性主动脉综合征（如夹层和破裂）方面的有效性在人群水平上尚不清楚。本研究评估了美国急性主动脉综合征手术发生率相对于近端主动脉手术量的趋势。方法：对 2005-2014 年全国住院患者样本进行回顾性分析。急性主动脉综合征和TAA通过国际疾病分类第9版诊断代码进行识别。近端主动脉手术被定义为通过主动脉手术和心脏停搏液、体外循环或其他心脏手术来诊断急性主动脉综合征或TAA。根据美国人口调整了急性主动脉综合征手术和近端胸动脉瘤手术的年发生率。使用线性回归评估趋势。结果：我们确定了 38 442 例急性主动脉诊断手术和 74 953 例 TAA 手术。急性主动脉综合征病例数从每 10 万人 0.93 例增加到 1.63 例（P = 0.001），动脉瘤手术从每 10 万人 1.75 例增加到 3.19 例（P < 0.001）。急性主动脉瘤手术和动脉瘤手术的患者和医院特征有所不同，其中黑人患者在动脉瘤人群中的代表性明显不足（4.9% vs 17.0%，P < 0.001）。 结论：从 2005 年到 2014 年，尽管近端主动脉瘤手术率有所增加，但急性主动脉综合征手术量有所增加。两组住院患者之间观察到患者特征存在差异，突出表明需要继续努力尽量减少社会人口差异。
OBJECTIVES: The effectiveness of proximal thoracic aortic aneurysm (TAA) surgery in preventing acute aortic syndromes, such as dissection and rupture, is unknown at the populational level. This study evaluated trends in acute aortic syndrome operation incidence relative to proximal aortic surgical volume in the USA.METHODS: A retrospective analysis of the National Inpatient Sample in 2005-2014 was performed. Acute aortic syndrome and TAA were identified with International Classification of Diseases, 9th edition diagnosis codes. Proximal aortic surgery was defined as the diagnosis of acute aortic syndrome or TAA with an aortic procedure and either cardioplegia, cardiopulmonary bypass or other cardiac operation. Annual rates of acute aortic syndrome surgery and proximal thoracic aneurysm surgery were adjusted for US population. Trends were evaluated using linear regression.RESULTS: We identified 38 442 operations for acute aortic diagnoses and 74 953 operations for TAAs. Case volume for acute aortic syndromes increased from 0.93 to 1.63 per 100 000 (P = 0.001), and aneurysm surgery increased from 1.75 to 3.19 per 100 000 (P < 0.001). Patient and hospital characteristics differed between acute aortic and aneurysm operations, with black patients being most notably underrepresented in the aneurysm population (4.9% vs 17.0%, P < 0.001).CONCLUSIONS: Acute aortic syndrome operative volume increased from 2005 to 2014 despite increasing rates of proximal aortic aneurysm surgery. Patient characteristic discrepancies were observed between the 2 groups of hospitalizations, highlighting the need for continued efforts to minimize sociodemographic disparities.