Comparing Trends Between 2004 and 2019 in Intact and Ruptured Abdominal, Thoracic, and Thoracoabdominal Aortic Aneurysms Spanning ICD9 and ICD10 Within the NIS Database

Given the changes in intervention guidelines and the growing popularity of endovascular treatment for aortic aneurysms since the turn of the millennium, we used the Nationwide Inpatient Sample to examine the trends in abdominal aortic aneurysm (AAA), thoracoabdominal aortic aneurysm (TAAA), and thoracic aortic aneurysm (TAA) rupture presentations and intact repairs along with the treatment methods (endovascular vs open). Analyses of aortic aneurysm trends spanning the change in coding from International Classification of Diseases, 9th or 10th edition, has yet to be studied. We identified all patients presenting with ruptured aortic aneurysms and intact aortic aneurysms intervened on in the Nationwide Inpatient Sample between 2004 and 2019. This included AAA, TAAA, and TAA. We then examined the utilization of open and endovascular repair for each aortic aneurysm location (AAA, TAAA, TAA), alongside their resulting in-hospital mortality, over time. We used Cochran-Armitage z statistic tests for a linear trend to generate trend P values for frequencies of hospitalizations, interventions, and other patient characteristics as well as linear regression tests for various outcome variables. Overall, we identified 717,570 patients with AAA (87% intact repair, 13% ruptured), 27,443 patients with TAAA (80% intact repair, 20% ruptured), and 141,652 patients with TAA (90% intact repair, 10% ruptured). Both intact AAA repairs and ruptured AAA hospitalizations decreased significantly between 2004 and 2019 (both trend P < 0.001). Intact TAAA repairs increased significantly (trend P < 0.001), while ruptured TAAA hospitalizations decreased significantly over the 15-year period (trend P < 0.001). Finally, intact TAA repairs increased significantly over the same period (trend P < 0.001), while ruptured TAA hospitalizations had no significant change (trend P = .381). Proportionally over time for AAA, the use of open repair decreased while the use of EVAR and c-EVAR increased (all trend P < .001) (Fig 1). Analyzing all intact aortic aneurysm repairs between 2004 and 2019, the mortality after AAA repairs decreased significantly, from 2.74% to 1.18% (−0.11%/year [95% confidence interval (CI), −0.12% to −0.08%]; P < .001), as well as after TAAA repairs decreased significantly, from 12.20% to 9.76% (−0.25%/year [95% CI, −0.44% to −0.05%]; P = .013), as well as after TAA repairs decreased significantly, from 3.54% to 2.35% (−0.07%/year [95% CI, −0.12% to −0.03%]; P < .001) (Fig 2). Both intact AAA repairs and ruptured AAA hospitalizations significantly decreased between 2004 and 2019. Conversely, intact TAAA and TAA repairs significantly increased. These increases in elective repairs are most likely driven by increasing utilization of endovascular repair, as well as new complex aortic interventions, allowing for treatment of patients otherwise unfit for surgical repair.Fig 2Trend in mortality after intact aortic aneurysm repair from 2004 to 2019, with respective linear regressions.View Large Image Figure ViewerDownload Hi-res image Download (PPT)