matthew s. slater, md, brian s. diggs, phd frederick a. tibayan, md steven g guyton, md, mph howard...
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Matthew S. Slater, MD, Brian S. Diggs, PhD
Frederick A. Tibayan, MDSteven G Guyton, MD, MPHHoward K. Song, MD, PhD
The Department of Surgery, and the Division of Cardiothoracic Surgery,
Oregon Health and Sciences University, Portland, Oregon
The Effect of Age on Cost and Outcomes Following Thoracic Aortic Dissection
The Effect of Age on Cost and Outcomes Following Thoracic Aortic Dissection
Aortic dissection is a highly lethal disease
The majority of aortic dissections, especially those in the thoracic aorta, occur in the elderly
Treatment can be medical, surgical, or endovascular
The effect of age on mortality, LOS and cost is poorly defined and important in the formulation treatment and resource allocation decisions
The National Inpatient Sample (NIS) Federally supported
1 in 5 hospitalized patients
Administrative data
In-hospital survival
ICD-9 disease and procedure codes
The Effect of Age on Cost and Outcomes Following Thoracic Aortic Dissection
This study is a retrospective analysis of aortic dissection utilizing the NISMortalityLOSCostDischarge disposition
Analysis focussed on thoracic dissection
MortalityUnder 70 v. Over 70
Utilization of the National Inpatient Sample (NIS) to Evaluate Aortic Disease
PRO: Large number of patients, cross section of the entire country
CON: Definitions and categories of disease not ideal
Thoracic Dissections: Mortality by Age
Patient Distribution Mortality
Linear increase in mortality with age,
particularly with surgical intervention
No clear “age threshold”
SurgeryNo Surgery SurgeryNo Surgery
Thoracic Dissections: OutcomesLOS Cost
No significant change in cost with age
No significant change in LOS with age
Surgery SurgeryNo Surgery No Surgery
Thoracic Dissections: Distribution of DC to Home
Percent Patients Discharged to Home by Age and surgery / No Surgery
SurgeryNo Surgery
Cost* per patient, per survivor, and per routine (to home) discharge
Surgery and No surgery combined
*Cost per survivor is total cost for entire cohort divided by number of survivors
Cost per patient, per survivor, and per routine (to home) discharge
Surgery and No surgery separated
LimitationsDefinitions of Dissection Limited data fields
NIS – “Thoracic”Thoracic + Surgery=Ascending
Thoracic – surgery= Descending
A and BAscending and Decending
I-IV
Length of follow-up
Quality of life evaluation
Pre-operative risk factors lacking, multivariate risk analysis limited
Conclusions: Thoracic Dissection
Mortality Cost and LOSThere is no discreet age above which mortality increases dramatically, rather the effect is linear.
Age “cutoffs” for limiting care for elderly patient with thoracic dissections are arbitrary.
Cost and length of stay remain constant despite increasing age for both surgery and medical patients. Therefore, neither cost nor LOS are relevant reasons to limit care in the elderly.
Although a lower percentage of elderly patient are discharged home, this has not been a traditional variable to determine care allocation