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