Trends in Management and Outcomes of Blunt Thoracic Aortic Injury in the United States

TL;DR

Blunt thoracic aortic injury cases doubled in the US over 14 years, with a shift from open surgery to less invasive TEVAR procedures.

Contribution

This study provides a 14-year analysis of BTAI management trends and outcomes in the US using a national database.

Findings

The estimated number of BTAI patients doubled from 2006 to 2019.

TEVAR use increased from 17% to 37%, while open aortic repair decreased significantly.

Mortality rates remained stable despite changes in treatment approaches.

Abstract

Blunt thoracic aortic injury (BTAI) is a significant cause of mortality and morbidity in the United States. The diagnosis and treatment of BTAI has evolved over the last few decades. This study aimed to examine the incidence and outcomes of thoracic endovascular aortic repair (TEVAR), non-operative management (NOM), and open aortic repair (OAR) for BTAI over a 14 year period.

Patients with BTAI from the National Inpatient Sample between 2006 – 2019 were studied and compared within three time periods: 2006–2010, 2011–2015, and 2016–2019. Waldtest and Pearson's chi-squared were performed to test whether management, patient characteristics, and in hospital mortality changed over time.

An estimate of 8 175 BTAI patients was identified, with an increasing estimate from 375 patients in 2006 to 750 patients in 2019. TEVAR utilisation increased from 17% to 37% during the study period, while those who received OAR and NOM decreased (OAR 16%–1.3%; NOM 67%–61%). There was an increasing trend in patients treated in an urban teaching hospital (2006–2010 vs. 2016–2019: 88% vs. 95%; p trend <0.001), and more patients were transferred from another hospital (12% vs. 18%; p trend = 0.027). Over the years, patients who received NOM were older (45 vs. 50 years; p < 0.001) and had more concurrent injuries, while the mortality rate among this group did not change (adjusted odds ratio [aOR] 0.65, 95% confidence interval [CI] 0.42–1.02; p = 0.060) Patients who received TEVAR were also older over the years (41 years vs. 46 years; p < 0.001), but they had fewer concurrent injuries, and the mortality rate remained stable (aOR 0.97, 95% CI 0.33–2.88; p = 0.96).

The estimated number of patients with BTAI was twice as large in 2019 compared with 2006, and the use of TEVAR increased, largely replacing OAR.

•The incidence of blunt thoracic aortic injury (BTAI) doubled over the 14 year study period.•The use of thoracic endovascular aortic repair (TEVAR) increased, largely replacing open aortic repair.•Mortality rates within the BTAI cohort remained relatively stable over the years.•There appears to be room for improvement in operative and conservative management.

The incidence of blunt thoracic aortic injury (BTAI) doubled over the 14 year study period.

The use of thoracic endovascular aortic repair (TEVAR) increased, largely replacing open aortic repair.

Mortality rates within the BTAI cohort remained relatively stable over the years.

There appears to be room for improvement in operative and conservative management.

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