دورية أكاديمية
Elective ascending aortic aneurysm repair outcomes in a nationwide US cohort.
| العنوان: | Elective ascending aortic aneurysm repair outcomes in a nationwide US cohort. |
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| المؤلفون: | Beyer SE; Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York, USA., Secemsky EA; Smith Center for Cardiovascular Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA., Khabbaz K; Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA., Carroll BJ; Smith Center for Cardiovascular Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA bcarrol2@bidmc.harvard.edu. |
| المصدر: | Heart (British Cardiac Society) [Heart] 2023 Jun 26; Vol. 109 (14), pp. 1080-1087. Date of Electronic Publication: 2023 Jun 26. |
| نوع المنشور: | Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: BMJ Pub. Group Country of Publication: England NLM ID: 9602087 Publication Model: Electronic Cited Medium: Internet ISSN: 1468-201X (Electronic) Linking ISSN: 13556037 NLM ISO Abbreviation: Heart Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: London : BMJ Pub. Group, c1996- |
| مواضيع طبية MeSH: | Aortic Aneurysm, Abdominal*/surgery , Aneurysm, Ascending Aorta* , Myocardial Infarction* , Stroke*/epidemiology , Stroke*/etiology , Endovascular Procedures*, Adult ; Humans ; Female ; Male ; Hospital Mortality ; Vascular Surgical Procedures/adverse effects ; Risk Factors ; Retrospective Studies ; Treatment Outcome ; Postoperative Complications ; Elective Surgical Procedures/adverse effects ; Risk Assessment |
| مستخلص: | Objective: To quantify contemporary outcomes following elective ascending aortic aneurysm repair, to determine risk factors for adverse events and to evaluate difference by institutional surgical volume. Methods: We included all elective hospitalisations of adult patients with an ascending aortic aneurysm who underwent aneurysm repair in the Nationwide Readmissions Database between 2016 and 2019. The primary outcome was a composite of in-hospital mortality, stroke (ischaemic and non-ischaemic) and myocardial infarction (MI). We identified independent predictor of adverse events and investigated outcomes by institutional volume. Results: Among 12 043 patients (mean 62.8 years of age, 28.0% female), MI, stroke or in-hospital death occurred in 598 (4.9%) patients during the index admission (acute stroke: 2.7%, MI: 0.7%, in-hospital death: 2.0%). The strongest predictors of in-hospital death, stroke or MI were chronic weight loss, pulmonary circulation disorder and concomitant descending aortic surgery. Higher procedural volume was associated with a lower incidence of in-hospital death, stroke or MI (OR comparing the highest with the lowest tertile 0.71, 95% CI 0.57 to 0.87; p=0.001) and in-hospital death (OR 0.51, 95% CI 0.37 to 0.72; p<0.001), but no difference in 30-day readmissions. Conclusions: The overall rate of in-hospital death, stroke and MI is nearly 5% in patients undergoing elective ascending aortic aneurysm repair. Among several predictors, chronic weight loss is associated with the largest increase in the risk of poor outcomes. Higher hospital volume is associated with a lower in-hospital mortality, highlighting the importance to refer patients to high-volume centres while discussing the risks and benefits of proceeding with repair. Competing Interests: Competing interests: EAS reports institutional research support from NIH/NHLBI (K23HL150290), Food & Drug Administration, BD, Boston Scientific, Cook, CSI, Laminate Medical, Medtronic and Philips. He is a consultant/speaker for Abbott, Bayer, BD, Boston Scientific, Cook, CSI, Medtronic, Philips and VentrureMed. BJC reports institutional research support from Bristol-Myers Squibb and Inari. He is a consultant for Reliant Medical and Janssen. (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.) |
| معلومات مُعتمدة: | K23 HL150290 United States HL NHLBI NIH HHS |
| فهرسة مساهمة: | Keywords: aortic aneurysm; outcome assessment, health care |
| تواريخ الأحداث: | Date Created: 20230317 Date Completed: 20230628 Latest Revision: 20230628 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1136/heartjnl-2022-322033 |
| PMID: | 36928243 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1468-201X |
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| DOI: | 10.1136/heartjnl-2022-322033 |