Department of Vascular Surgery, 92323Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Biostatistics, 92323Zhongshan Hospital, Fudan University, Shanghai, China.
Vasc Endovascular Surg. 2021 May;55(4):332-341. doi: 10.1177/1538574420983652. Epub 2020 Dec 29.
OBJECTIVE/BACKGROUND: This study examined the 10-year hospitalization characteristics, economic patterns and early clinical outcomes of type B aortic dissection (TBAD) patients that underwent thoracic endovascular aortic repair (TEVAR) in one high-volume hospital in China.
We performed a population-based retrospective analysis based on electronic medical record system data provided by Zhongshan Hospital Fudan University from 2009 to 2018.
We identified 1,367 cases of TBAD patients with TEVAR over the past decade. The total incidence of in-hospital complications was 7.6% (104 of 1,367), among which acute kidney injury (AKI) had the highest incidence (3.1%, 42 of 1,367). Aortic-related reintervention was performed in 7 patients (0.5%). The overall aortic-related in-hospital mortality rate was 2.7% (37 of 1,367) and had no significant time-varying trend ( = 0.2). Among these, 27% of in-hospital deaths were caused by retrograde type A dissection (RTAD). Chronic TBAD had a higher risk of in-hospital death versus acute TBAD, with a risk ratio of 2.69 (95% confidence interval [CI]: 1.19-6.09). Patients with hypertension (risk ratio 4.63, 95% CI: 1.38, 15.54) also had a higher in-hospital death risk. These 2 factors were also the predictive factors for the composite endpoint of in-hospital adverse events (risk ratio 2.17, 95% CI: 1.43, 3.29 and risk ratio 4.83, 95% CI: 1.90, 12.28, respectively), in addition to Marfan syndrome (risk ratio 4.05, 95% CI: 1.61, 10.19). The average length of hospitalization significantly declined during the past decade (annual percentage change -6.3%, 95% CI -8.2 to -4.3), and the stent-grafts (SGs) cost was the main expenditure of the total hospitalization costs.
Our study showed a favorable early outcome of TEVAR over the past decade. Greater attention should be paid to certain risk factors in order to reduce the in-hospital adverse events. SG expenditure is still the primary economic burden on Chinese TBAD patients.
目的/背景：本研究旨在探讨一家中国大型医院接受胸主动脉腔内修复术（TEVAR）治疗的 B 型主动脉夹层（TBAD）患者的 10 年住院特征、经济模式和早期临床结局。
我们基于复旦大学中山医院 2009 年至 2018 年的电子病历系统数据进行了一项基于人群的回顾性分析。
在过去的十年中，我们共发现 1367 例接受 TEVAR 治疗的 TBAD 患者。总的院内并发症发生率为 7.6%（104/1367），其中急性肾损伤（AKI）发生率最高（3.1%，42/1367）。有 7 例患者（0.5%）进行了主动脉相关的再次介入治疗。总的主动脉相关院内死亡率为 2.7%（37/1367），且无显著的时间变化趋势（ = 0.2）。其中，27%的院内死亡是由逆行性 A 型夹层（RTAD）引起的。慢性 TBAD 比急性 TBAD 的院内死亡风险更高，风险比为 2.69（95%置信区间[CI]：1.19-6.09）。高血压患者（风险比 4.63，95%CI：1.38-15.54）的院内死亡风险也更高。这两个因素也是院内不良事件复合终点的预测因素（风险比 2.17，95%CI：1.43-3.29 和风险比 4.83，95%CI：1.90-12.28），此外，马凡综合征也是预测因素（风险比 4.05，95%CI：1.61-10.19）。过去十年间，患者的平均住院时间显著缩短（年百分比变化-6.3%，95%CI：-8.2 至-4.3），支架移植物（SG）费用是总住院费用的主要支出。
本研究显示过去十年 TEVAR 的早期结果良好。应更加关注某些危险因素，以降低院内不良事件的发生。SG 支出仍然是中国 TBAD 患者的主要经济负担。
