Effect of Ethnicity and Insurance Type on Open Thoracic Aneurysm Repair Outcome

OBJECTIVES:Mortality and complication rates for open thoracic aortic aneurysm repair have declined but still remain high. The purpose of this study is to determine the influence of ethnicity and insurance type on procedure selection and outcome following open thoracic aneurysm repair.
METHODS: Using the Nationwide Inpatient Sample (NIS) database ethnicity and insurance type were evaluated against the outcome variables of mortality and major complications associated with open thoracic aneurysm repair. The potential cofounders of age, gender, operative location, diabetes, and Deyo index of comorbidities were controlled.
RESULTS: Between 2001-2005 a total of 10,557 patients were identified who underwent elective open thoracic aneurysm repair with a significantly greater proportion of Caucasians (n=8524) compared to African American (819) or Hispanic (556) with 658 patients categorized as other. The majority of patients (67%) were male and 55% of the procedures were elective. Overall mortality was 10.7% (n=1126) and spinal cord ischemia was 0.4% (n=43). Univariate analysis revealed significant differences among race with regard to surgery type, income, hospital region, hospital bed size, and insurance type (p<0.0001). Differences between insurance coverage were significant for gender, surgery type, income, hospital region, and race (p<0.0001). Bivariate analysis by race revealed differences for death (p<0.0001), pneumonia (p<0.0001), delirium (p=0.008), renal complications (p=0.011), implant complications (p<0.0001), temporary tracheostomy (p=0.004), transfusion (p<0.0001) and intubation (p<0.0001). Bivariate analysis by insurance coverage revealed differences in death (p<0.0001), CNS complications (p=0.008), pneumonia (p<0.0001), MI (p=0.001), infection (p<0.0001), renal complications (p<0.0001), malnutrition (p<0.0001), temporary tracheostomy (p<0.0001), spinal cord ischemia (p=0.001), transfusion (p<0.0001), and intubation (p<0.0001).
CONCLUSIONS:Ethnicity and insurance type is associated with different rates of complications and mortality in open thoracic aneurysm repair and does influence surgical outcome. Forty-five percent of open thoracic procedures performed in the United States are urgent or emergent. Future studies that break down emergent versus elective repair should be considered.