National Trends and Clinical Outcomes of Type B Aortic Dissection Management at Safety-Net Hospitals

Abstract

Introduction Patients with type B aortic dissection (TBAD) are often underinsured and urgently admitted for open or thoracic endovascular aortic repair (TEVAR). The present study evaluated the association of safety-net status with outcomes among patients with TBAD. Methods The 2012-2019 National Inpatient Sample was queried to identify all adults admitted with type B aortic dissection. Safety-net hospitals (SNHs) were defined as institutions in the top 33% for the annual proportion of uninsured or Medicaid patients. Multivariable regression models were utilized to assess the association of SNH with in-hospital mortality, perioperative complications, length of stay (LOS), hospitalization cost, and non-home discharge. Results Of an estimated 172 595 patients, 61 000 (35.3%) were managed at SNH. Compared to others, patients admitted to SNH were younger, more commonly non-white, and more frequently non-electively admitted. From 2012 to 2019, the annual incidence of type B aortic dissection increased in the overall cohort. Additionally, utilization of TEVAR at non-SNH increased significantly (2012: 6.5% vs 2019: 9.8%), while that of SNH remained similar (2012: 7.4% vs 2019: 7.9%). Patients undergoing open repair had higher mortality at both SNH (12.4 vs 7.8%, P < .001) and non-SNH (13.1 vs 6.1%, P < .001) compared to those receiving TEVAR. After risk adjustment, compared to non-SNH, SNH status was associated with greater odds of mortality, perioperative complications and non-home discharge. Conclusions Our finding suggests that SNH have inferior clinical outcomes for TBAD as well as reduced adoption of endovascular management strategies. Future studies to identify barriers to optimal aortic repair and ameliorate disparities at SNH are warranted.