Article

Effects of ethnicity and insurance status on outcomes after thoracic endoluminal aortic aneurysm repair (TEVAR)

Division of Vascular Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter (Impact Factor: 3.02). 04/2010; 51(4 Suppl):14S-20S. DOI: 10.1016/j.jvs.2009.11.079
Source: PubMed

ABSTRACT

Thoracic endoluminal aortic aneurysm repair (TEVAR) is associated with improved outcomes compared with open thoracic aortic aneurysm repair. This study was designed to better characterize TEVAR outcomes in a large population, and to determine if outcomes are independently influenced by patient ethnicity and insurance status.
Using the Nationwide Inpatient Sample (NIS) database, we selected patients who underwent TEVAR between 2001 and 2005. Ethnicity and insurance type were independently evaluated against the outcome variables of mortality and postoperative complications. Age, gender, hospital region, hospital location, hospital size, and comorbidities were controlled as cofounders.
Between 2001 and 2005, 875 patients underwent TEVAR. There was a significantly greater proportion of Caucasians (n = 650) compared with African Americans (n = 104) or Hispanics (n = 49). Patients had a male preponderance, and most procedures were elective. The overall mortality was 13.3% (n = 117), and spinal cord ischemia was 0.8% (n = 7), with no differences between patients of varied ethnicity or payer status. Significant differences were noted among the races including gender (P = .003), income (P < .0001), hospital region (P < .001), hospital bed size (P = .013), and insurance type (P < .001). Significant variations in demographics characteristics were also present between patients with different insurance classifications including gender (P < .001), surgery type (P = .009), income (P = .003), race (P < .0001), and comorbidity index (P < .0001). After adjustment for cofounders and multiple comparisons, there were no differences in rates of complications among patients with varying race or insurance status.
Mortality after TEVAR remains high in the US, although this may be associated with its early introduction during the study period. Nonetheless, the incidence of spinal cord ischemia is very low. Ethnicity and insurance type do not appear to influence TEVAR outcomes.

Download full-text

Full-text

Available from: Erin H Murphy, Mar 17, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Thoracic endovascular aneurysm repair (TEVAR) is gaining acceptance since Food and Drug Administration approval in 2005. We hypothesize that, compared with open repair (OPEN), mortality and complication rate after TEVAR have continued to improve. All patients who underwent thoracic and (or) thoracoabdominal aneurysm repair from 2005 to 2007 in the Nationwide Inpatient Sample were examined. Patients were stratified by TEVAR or OPEN. Demographics, hospital characteristics, and outcomes were analyzed. Multivariable logistic regression models for complications and in-hospital mortality were developed. A weighted total of 7,644 had TEVAR, while 32,948 patients underwent OPEN. The TEVAR utilization increased from 5.5% (2005) to 24.1% (2007). Mortality for all patients undergoing thoracic aneurysm repair decreased yearly (p<0.001). Mortality (TEVAR: 7.3%, OPEN: 9.8%, p<0.001) and complication rate (TEVAR: 24.3%, OPEN: 42.1%, p<0.001) were superior with TEVAR. The unadjusted annual mortality (7%) and complication rate (24%) after TEVAR did not improve each year; however, after risk adjustment, mortality after TEVAR steadily decreased annually. Moreover, risk-adjusted mortality for OPEN has improved since 2005. Multivariate analysis revealed age and ruptured aneurysm were highly predictive of death (p<0.001, respectively), while TEVAR lowered the adjusted odds of death by 18% (p<0.05). Mortality in patients undergoing repair of thoracic aneurysms has decreased in the United States since Food and Drug Administration approval of stent grafts in 2005. This is due to wider adoption of TEVAR and improved mortality in patients undergoing TEVAR or open repair.
    Preview · Article · Mar 2011 · The Annals of thoracic surgery
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A growing body of literature in vascular surgery demonstrates disparities in the type of health care that racial/ethnic minorities receive in the United States. Numerous recommendations, including those of the Institute of Medicine, have been set forth, which identify increasing the number of minority health professionals as a key strategy to eliminating health disparities. The purpose of this study is to compare the racial/ethnic distribution of the Society for Vascular Surgery (SVS) membership, the SVS leadership, vascular surgery trainees, and medical students. The results demonstrate that the racial/ethnic distribution of the SVS membership reflects a considerable lack of diversity with a paucity of diversity among the SVS leadership. An increasing rate of racial/ethnic diversity among vascular surgery trainees may indicate that the SVS will see an improvement in diversity in the future.
    Full-text · Article · Dec 2012 · Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter

  • No preview · Article · Jan 2013 · Journal of the American College of Surgeons
Show more