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Short Term Outcomes in Endovascular and Open Repair of Thoracic Aortic Aneurysms Are Controversial Through NSQIP. Alexander I. Kraev , MD Andrew Nguyen, MD R Anthony Perez-Tamayo, MD PhD Gregg Landis, MD. National Surgical Quality Improvement Program (NSQIP). - PowerPoint PPT Presentation
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Aortic Symposium 2012
Short Term Outcomes in Endovascular and Open Repair of Thoracic Aortic Aneurysms
Are Controversial Through NSQIP
Alexander I. Kraev, MDAndrew Nguyen, MD
R Anthony Perez-Tamayo, MD PhDGregg Landis, MD
Aortic Symposium 2012
National Surgical Quality Improvement Program (NSQIP)
• Administered by the American College of Surgeons– Join Commission Surgical Care Improvement Project
• 400 Centers participating across United States– Teaching and non-teaching hospitals
• 136 Perioperative variables measured– Preoperative risk factors– Intraoperative variables– 30-day post-op morbidity and mortality outcomes
Aortic Symposium 2012
TEVAR
• Thoracic Endovascular Aneurysm Repair– Minimally invasive option to the traditional
open repair• Initial experience at specialty institutions
– Highly favorable towards TEVAR• Currently widely adopted across the
country– Prospective and long-term studies are lacking
Aortic Symposium 2012
NSQIP 2005-2009 Database
• 12162 total aortic cases– 7374 endovascular repairs– 4788 open repairs
Elective Emergency Total
Open Repair 102 16 118TEVAR 635 128 763Total 737 144 881
Aortic Symposium 2012
NSQIP Database
Aortic Symposium 2012
Descriptive Statistics
TEVAR Open P-valueAge (years) 68.5 67.6 .54Male % 59.7 62.7 .55Op Time (min) 170.2 233.8 <.0001Anesth Time (min) 272.2 338.2 <.0001Return to OR (yes %) 12.3% 13.6% .66ASA III/IV (%) 94.6 90.7 .58Emergency (%) 16.7 13.6 .38LOS (days) 7.4 10.8 <.001
Aortic Symposium 2012
TEVAR vs Open Mortality
Aortic Symposium 2012
TEVAR vs Open: Cardiac Outcomes
• Combined end-point of cardiac arrest or acute myocardial infarction
Aortic Symposium 2012
TEVAR vs Open: Pulmonary Outcomes
• Combined end-point of prolonged intubation, re-intubation, pulmonary embolism, or pneumonia
Aortic Symposium 2012
TEVAR vs Open: Renal Outcomes
• Combined end-point of acute renal insufficiency or acute renal failure
Aortic Symposium 2012
TEVAR vs Open: Post-Operative Stroke
Aortic Symposium 2012
Conclusion
• Short term mortality of TEVAR and open repair are equivalent
• Operative time, anesthesia time, and length of stay are shorter in TEVAR
• Pulmonary and renal outcomes are superior in TEVAR
• Stroke rate is higher in TEVAR
