Contemporary Unplanned Readmission Trends Following Management of Type B Aortic Dissection

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Thoracic Surgery

Background:

• Thoracic endovascular aortic repair (TEVAR) shows improved survival in large studies compared to medical therapy.
• Early TEVAR for acute type B aortic dissection (TBAD) remains a subject of controversy.
• Understanding readmission trends and predictors is crucial for optimizing TBAD management.

Purpose of the Study:

• To evaluate trends in hospital readmissions for acute type B aortic dissection (TBAD).
• To identify clinical predictors of readmission in patients managed medically or with TEVAR.
• To compare readmission rates and costs between medical management and TEVAR for acute TBAD.

Main Methods:

• Analysis of the Nationwide Readmissions Database (2012-2015) for acute TBAD patients.
• Inclusion of 30-day and 90-day index readmissions (30D-IR, 90D-IR).
• Multivariable logistic regression to identify readmission predictors for both management strategies.

Main Results:

• Older age, lower income, comorbidities, longer hospital stay, and urgent procedures predicted higher readmission likelihood.
• Unplanned readmission rates for medical management remained stable (30D-IR: 11.3% vs. 10.0%; 90D-IR: 19.1% vs. 15.5%).
• TEVAR readmissions were mainly due to technical complications; no significant cost difference was observed.

Conclusions:

• Unplanned readmissions in the TEVAR group significantly decreased over the study period.
• Readmissions for medical management of TBAD remained consistent.
• TEVAR may offer a declining readmission benefit over time for acute TBAD.