The outcome in the United States after thoracoabdominal aortic aneurysm repair, renal artery bypass, and mesenteric revascularization

Objectives: The purpose of this study was to determine outcome and identify predictors of death after thoracoabdominal aortic aneurysm (TAA) repair, r enal artery bypass (RAB), and revascularization for chronic mesenteric isch emia (CMI). Patients and Methods: In this retrospective analysis, data were obtained fr om the Nationwide Inpatient Sample, a 20% all-payer stratified sample of ho spitals in the United States during 1993 to 1997. Patients were identified by the presence of a diagnostic or procedure code from the international Cl assification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The main outcomes we examined were death, ICD-PCM-based complications, len gth of stay, hospital charges, and disposition. A multivariate model was co nstructed to predict death. Results: A total of 2934 patients were identified (TAA, 540; RAB, 2058; CMI , 336) in the database. The mean age was comparable (TAA, 69 +/- 9 years; R AB, 66 +/- 12 years; CMI, 66 +/- 11 years), but the breakdown between the s exes varied by procedure (male: TAA, 53%; RAB, 55%; CMI, 24%). The mortalit y rate (TAA, 20.3%; RAB, 7.1%; CMI, 14.7%), complication rate (TAA, 62.2%; RAB, 37.4%; CMI, 44.6%), and the percentage of patients discharged to anoth er institution (TAA, 21.2%; RAB, 9.3%; CMI, 12.0%) were clinically signific ant for all procedures. The mortality rate for RAB was greater when perform ed concomitant with an aortic reconstruction (4.4% vs 8.3%). All three proc edures were resource intensive as reflected by the median length of stay (T AA, 14 days; RAB, 9 days; CMI, 14 days) and median hospital charges (TAA, $ 64,493; RAB, $36,830; CMI, $47,390). The multivariate model identified seve ral variables for each procedure that had an impact on the predicted mortal ity rate (TAA, 14%-76%; RAB, < 1%-46%; CMI, < 2%-87%). Conclusions: The operative mortality rates across the United States for pat ients undergoing TAA. repair and RAB are greater than commonly reported in the literature and mandate reexamining the treatment strategies for these c omplex vascular problems.