Baylor College of Medicine, Houston, TX, USA.
J Thorac Cardiovasc Surg. 2012 Sep;144(3):612-6. doi: 10.1016/j.jtcvs.2011.10.098.
Thoracic endovascular aortic repair (TEVAR) has been gaining popularity for the treatment of thoracoabdominal aortic aneurysm (TAAA). We used a nonvoluntary database to examine national trends and regional/hospital variations in the use of TEVAR and open thoracic aortic repair (OTAR) for TAAA.
From the 2005-2008 Nationwide Inpatient Sample database, we identified all patients with the diagnosis of TAAA who were treated with TEVAR or OTAR. Rates of these procedures were compared between years, across geographic regions, and between hospitals of various bed sizes.
Over the study period, the rate of OTAR remained relatively stable (range, 7.5/100 patients in 2005 to 10.1/100 patients in 2008; P = .26), whereas the rate of TEVAR increased dramatically (range, 1.4/100 patients in 2005 to 6.3/100 patients in 2008; P < .0001). In 2008, 29% (211) of all TEVAR procedures and 11% (130) of all OTAR procedures were performed in western regions of the United States (P = .03). Additionally, 13% (95) of all TEVAR procedures and 3% (35) of all OTAR procedures were performed in smaller hospitals (P < .0001).
The use of TEVAR for TAAA repair increased significantly over the study period, whereas OTAR rates remained relatively stable. Our findings suggest that more patients who were otherwise not surgical candidates or did not have traditional surgical indications for OTAR were treated with TEVAR, most commonly in regions or hospitals where OTAR is less often performed. Given the complexity of TAAA cases, these results may have significant implications for patient safety in the current era of heightened health care scrutiny.
胸主动脉腔内修复术（TEVAR）在治疗胸腹主动脉瘤（TAAA）方面越来越受欢迎。我们使用非自愿数据库来研究全国范围内 TEVAR 和开放胸主动脉修复术（OTAR）治疗 TAAA 的趋势以及区域/医院差异。
从 2005 年至 2008 年全国住院患者样本数据库中，我们确定了所有接受 TEVAR 或 OTAR 治疗的 TAAA 患者。比较了这些手术在不同年份、不同地理区域和不同床位数医院之间的比例。
在研究期间，OTAR 的比例相对稳定（2005 年为 7.5/100 例，2008 年为 10.1/100 例；P =.26），而 TEVAR 的比例则急剧增加（2005 年为 1.4/100 例，2008 年为 6.3/100 例；P <.0001）。2008 年，美国西部地区进行了 29%（211 例）的所有 TEVAR 手术和 11%（130 例）的所有 OTAR 手术（P =.03）。此外，较小的医院进行了 13%（95 例）的所有 TEVAR 手术和 3%（35 例）的所有 OTAR 手术（P <.0001）。
在研究期间，TEVAR 治疗 TAAA 的使用显著增加，而 OTAR 比例相对稳定。我们的发现表明，更多原本不符合手术条件或不符合 OTAR 传统手术适应证的患者接受了 TEVAR 治疗，最常见于 OTAR 手术较少进行的地区或医院。鉴于 TAAA 病例的复杂性，这些结果可能对当前医疗保健审查加强时代的患者安全产生重大影响。
