Department of Surgery, Kendall Regional Medical Center, Miami, Florida.
Department of Surgery, Kendall Regional Medical Center, Miami, Florida.
J Surg Res. 2020 Jan;245:179-182. doi: 10.1016/j.jss.2019.07.076. Epub 2019 Aug 14.
Blunt thoracic aortic injuries (BTAIs) carry a substantial mortality rate. Our study aimed to compare the outcomes of thoracic endovascular aortic repair (TEVAR) with open repair from trauma centers across the United States using the National Trauma Data Bank-Research Data Set (RDS).
The National Trauma Data Bank-RDS was reviewed for thoracic aortic injures and repair methods. Patients were divided into two groups: TEVAR versus open repair. Demographics and outcomes were compared between groups. Mortality rate was adjusted using the observed/expected mortality (O/E), with TRISS methodology by using the Revised Trauma Score with the Injury Severity Score. Chi-square test and t-test were used with significance defined as P < 0.05.
Within the 2016 RDS, there were 275 cases that underwent operative repair for BTAI. Of the 275 operative cases, 62.5% (172/275) had TEVAR and 37.5% (103/275) underwent open repair. Mean age in TEVAR group was 41 and open repair group was 36 (P > 0.05). Mean Injury Severity Score for TEVAR was 36 versus 35 for open repair (P > 0.05). Mean Revised Trauma Score was 6.7 in TEVAR versus 5.5 in open group (P > 0.05). TEVAR patients had significantly lower crude mortality rate versus open repair (11% versus 25.2%, P < 0.005). When adjusted using O/E, the TEVAR group also had significantly less deaths versus open repair (0.40 versus 0.68, P < 0.000008).
For BTAIs, thoracic endovascular aortic repairs were superior to open repair on injury-adjusted, all-cause mortality.
钝性胸主动脉损伤（BTAI）的死亡率很高。我们的研究旨在使用国家创伤数据库-研究数据集（RDS）比较美国创伤中心的胸主动脉腔内修复术（TEVAR）与开放修复的结果。
对国家创伤数据库-RDS 中的胸主动脉损伤和修复方法进行了回顾。患者分为两组：TEVAR 与开放修复。比较两组间的人口统计学和结果。使用观察/预期死亡率（O/E）和创伤评分修订版（TRISS）方法，用损伤严重程度评分调整死亡率。使用卡方检验和 t 检验，P<0.05 为差异有统计学意义。
在 2016 年 RDS 中，有 275 例患者因 BTAI 接受手术治疗。在 275 例手术病例中，62.5%（172/275）行 TEVAR，37.5%（103/275）行开放修复。TEVAR 组的平均年龄为 41 岁，开放修复组为 36 岁（P>0.05）。TEVAR 组的平均损伤严重程度评分（ISS）为 36，开放修复组为 35（P>0.05）。TEVAR 组的修订创伤评分（RTS）平均为 6.7，开放组为 5.5（P>0.05）。TEVAR 患者的死亡率明显低于开放修复组（11%比 25.2%，P<0.005）。使用 O/E 调整后，TEVAR 组的死亡率也明显低于开放修复组（0.40 比 0.68，P<0.000008）。
对于 BTAI，在损伤调整后的全因死亡率方面，胸主动脉腔内修复术优于开放修复术。
