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The Effect of Age on Cost and Outcomes Following Thoracic Aortic Dissection

The Effect of Age on Cost and Outcomes Following Thoracic Aortic Dissection.

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The Effect of Age on Cost and Outcomes Following Thoracic Aortic Dissection

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  1. The Effect of Age on Cost and Outcomes Following Thoracic Aortic Dissection Matthew S. Slater, MD, Brian S. Diggs, PhDFrederick A. Tibayan, MDSteven G Guyton, MD, MPHHoward K. Song, MD, PhDThe Department of Surgery, and the Division of Cardiothoracic Surgery, Oregon Health and Sciences University, Portland, Oregon

  2. 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

  3. The Effect of Age on Cost and Outcomes Following Thoracic Aortic Dissection • This study is a retrospective analysis of aortic dissection utilizing the NIS • Mortality • LOS • Cost • Discharge disposition • Analysis focussed on thoracic dissection

  4. Mortality Under 70 v. Over 70

  5. 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

  6. Thoracic Dissections: Mortality by Age Patient Distribution Mortality No Surgery Surgery No Surgery Surgery Linear increase in mortality with age, particularly with surgical intervention No clear “age threshold”

  7. Thoracic Dissections: Outcomes No Surgery Surgery No Surgery Surgery LOS Cost No significant change in LOS with age No significant change in cost with age

  8. Thoracic Dissections: Distribution of DC to Home Percent Patients Discharged to Home by Age and surgery / No Surgery No Surgery Surgery

  9. 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

  10. Costper patient, per survivor, and per routine (to home) discharge Surgery and No surgery separated

  11. Limitations Definitions of Dissection Limited data fields NIS – “Thoracic” Thoracic + Surgery=Ascending Thoracic – surgery= Descending A and B Ascending and Decending I-IV Length of follow-up Quality of life evaluation Pre-operative risk factors lacking, multivariate risk analysis limited

  12. Conclusions: Thoracic Dissection Mortality Cost and LOS There 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

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