Effects of ethnicity and insurance status on outcomes after thoracic endoluminal aortic aneurysm repair (TEVAR)

Erin H. Murphy, Charles M. Davis, J. Gregory Modrall, G. Patrick Clagett, Frank R. Arko

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Thoracic endoluminal aortic aneurysm repair (TEVAR) is associated with improved outcomes compared with open thoracic aortic aneurysm repair. This study was designed to better characterize TEVAR outcomes in a large population, and to determine if outcomes are independently influenced by patient ethnicity and insurance status. Methods: Using the Nationwide Inpatient Sample (NIS) database, we selected patients who underwent TEVAR between 2001 and 2005. Ethnicity and insurance type were independently evaluated against the outcome variables of mortality and postoperative complications. Age, gender, hospital region, hospital location, hospital size, and comorbidities were controlled as cofounders. Results: Between 2001 and 2005, 875 patients underwent TEVAR. There was a significantly greater proportion of Caucasians (n = 650) compared with African Americans (n = 104) or Hispanics (n = 49). Patients had a male preponderance, and most procedures were elective. The overall mortality was 13.3% (n = 117), and spinal cord ischemia was 0.8% (n = 7), with no differences between patients of varied ethnicity or payer status. Significant differences were noted among the races including gender (P = .003), income (P < .0001), hospital region (P < .001), hospital bed size (P = .013), and insurance type (P < .001). Significant variations in demographics characteristics were also present between patients with different insurance classifications including gender (P < .001), surgery type (P = .009), income (P = .003), race (P < .0001), and comorbidity index (P < .0001). After adjustment for cofounders and multiple comparisons, there were no differences in rates of complications among patients with varying race or insurance status. Conclusions: Mortality after TEVAR remains high in the US, although this may be associated with its early introduction during the study period. Nonetheless, the incidence of spinal cord ischemia is very low. Ethnicity and insurance type do not appear to influence TEVAR outcomes.

Original languageEnglish (US)
JournalJournal of Vascular Surgery
Volume51
Issue number4 SUPPL.
DOIs
StatePublished - Apr 2010

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Thoracic Aortic Aneurysm
Insurance Coverage
Insurance
Spinal Cord Ischemia
Mortality
Comorbidity
Hospital Bed Capacity
Health Facility Size
Hispanic Americans
African Americans
Inpatients
Demography
Databases
Incidence
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Effects of ethnicity and insurance status on outcomes after thoracic endoluminal aortic aneurysm repair (TEVAR). / Murphy, Erin H.; Davis, Charles M.; Modrall, J. Gregory; Clagett, G. Patrick; Arko, Frank R.

In: Journal of Vascular Surgery, Vol. 51, No. 4 SUPPL., 04.2010.

Research output: Contribution to journalArticle

Murphy, Erin H. ; Davis, Charles M. ; Modrall, J. Gregory ; Clagett, G. Patrick ; Arko, Frank R. / Effects of ethnicity and insurance status on outcomes after thoracic endoluminal aortic aneurysm repair (TEVAR). In: Journal of Vascular Surgery. 2010 ; Vol. 51, No. 4 SUPPL.
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abstract = "Background: Thoracic endoluminal aortic aneurysm repair (TEVAR) is associated with improved outcomes compared with open thoracic aortic aneurysm repair. This study was designed to better characterize TEVAR outcomes in a large population, and to determine if outcomes are independently influenced by patient ethnicity and insurance status. Methods: Using the Nationwide Inpatient Sample (NIS) database, we selected patients who underwent TEVAR between 2001 and 2005. Ethnicity and insurance type were independently evaluated against the outcome variables of mortality and postoperative complications. Age, gender, hospital region, hospital location, hospital size, and comorbidities were controlled as cofounders. Results: Between 2001 and 2005, 875 patients underwent TEVAR. There was a significantly greater proportion of Caucasians (n = 650) compared with African Americans (n = 104) or Hispanics (n = 49). Patients had a male preponderance, and most procedures were elective. The overall mortality was 13.3{\%} (n = 117), and spinal cord ischemia was 0.8{\%} (n = 7), with no differences between patients of varied ethnicity or payer status. Significant differences were noted among the races including gender (P = .003), income (P < .0001), hospital region (P < .001), hospital bed size (P = .013), and insurance type (P < .001). Significant variations in demographics characteristics were also present between patients with different insurance classifications including gender (P < .001), surgery type (P = .009), income (P = .003), race (P < .0001), and comorbidity index (P < .0001). After adjustment for cofounders and multiple comparisons, there were no differences in rates of complications among patients with varying race or insurance status. Conclusions: Mortality after TEVAR remains high in the US, although this may be associated with its early introduction during the study period. Nonetheless, the incidence of spinal cord ischemia is very low. Ethnicity and insurance type do not appear to influence TEVAR outcomes.",
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