Hospital survival of aortic dissection in children

Hong Uyen Hua, Jun Tashiro, Casey J. Allen, Jorge Rey, Eduardo Perez, Juan E Sola

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background Thoracic aortic dissection (AD) is a rare occurrence in childhood and mostly associated with connective tissue disorders or congenital abnormalities. We examined the characteristics associated with AD and predictors of survival. Methods The Kids' Inpatient Database (1997-2009) was used to identify thoracic ADs occurring in patients <20-y-old. Clinical characteristics, as well as determinants of survival, were analyzed using standard statistical methods. Results One hundred sixty-eight cases of thoracic AD were identified during the study period. Overall survival was 83%. Average length of stay was 15.9 ± 16.9 d, with charges 181,867.92 ± $211,985.00. Thoracic dissection tended to affect adolescents aged 15-19 y (67%), males (76%), and Caucasians (56%) most frequently. Most patients were privately insured (64%) and treated at urban teaching centers (86%). Commonly associated diagnoses were hypertension (18%), Marfan syndrome (15%), and aortic valve disorders (8%). When repair was performed, open repair was more frequent (88%) than endovascular repair (6%). Hemorrhage was the most common complication (19%). Multiple determinants of survival were found. Girls (mortality odds ratio: 0.21 [0.05-0.91]) fared better than boys, P = 0.023. Patients with Medicaid (2.84 [1.21-6.69]) had higher mortality versus privately insured, P = 0.014. Income, race, and hospital characteristics, and type of repair were not significant predictors, even on sub-analyses of surgical and nonsurgical groups separately. Conclusions Dissection of the thoracic aorta is a rare but significant condition affecting the pediatric population. Most repairs are performed using open technique. Payer status and gender are predictors of survival in these cases.

Original languageEnglish (US)
Pages (from-to)399-403
Number of pages5
JournalJournal of Surgical Research
Volume196
Issue number2
DOIs
StatePublished - Jun 15 2015

Fingerprint

Dissection
Thorax
Survival
Marfan Syndrome
Mortality
Medicaid
Thoracic Aorta
Aortic Valve
Connective Tissue
Inpatients
Length of Stay
Teaching
Odds Ratio
Databases
Pediatrics
Hemorrhage
Hypertension
Population

Keywords

  • Aorta
  • Aortic diseases
  • Outcomes research

ASJC Scopus subject areas

  • Surgery

Cite this

Hospital survival of aortic dissection in children. / Hua, Hong Uyen; Tashiro, Jun; Allen, Casey J.; Rey, Jorge; Perez, Eduardo; Sola, Juan E.

In: Journal of Surgical Research, Vol. 196, No. 2, 15.06.2015, p. 399-403.

Research output: Contribution to journalArticle

Hua, Hong Uyen ; Tashiro, Jun ; Allen, Casey J. ; Rey, Jorge ; Perez, Eduardo ; Sola, Juan E. / Hospital survival of aortic dissection in children. In: Journal of Surgical Research. 2015 ; Vol. 196, No. 2. pp. 399-403.
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abstract = "Background Thoracic aortic dissection (AD) is a rare occurrence in childhood and mostly associated with connective tissue disorders or congenital abnormalities. We examined the characteristics associated with AD and predictors of survival. Methods The Kids' Inpatient Database (1997-2009) was used to identify thoracic ADs occurring in patients <20-y-old. Clinical characteristics, as well as determinants of survival, were analyzed using standard statistical methods. Results One hundred sixty-eight cases of thoracic AD were identified during the study period. Overall survival was 83{\%}. Average length of stay was 15.9 ± 16.9 d, with charges 181,867.92 ± $211,985.00. Thoracic dissection tended to affect adolescents aged 15-19 y (67{\%}), males (76{\%}), and Caucasians (56{\%}) most frequently. Most patients were privately insured (64{\%}) and treated at urban teaching centers (86{\%}). Commonly associated diagnoses were hypertension (18{\%}), Marfan syndrome (15{\%}), and aortic valve disorders (8{\%}). When repair was performed, open repair was more frequent (88{\%}) than endovascular repair (6{\%}). Hemorrhage was the most common complication (19{\%}). Multiple determinants of survival were found. Girls (mortality odds ratio: 0.21 [0.05-0.91]) fared better than boys, P = 0.023. Patients with Medicaid (2.84 [1.21-6.69]) had higher mortality versus privately insured, P = 0.014. Income, race, and hospital characteristics, and type of repair were not significant predictors, even on sub-analyses of surgical and nonsurgical groups separately. Conclusions Dissection of the thoracic aorta is a rare but significant condition affecting the pediatric population. Most repairs are performed using open technique. Payer status and gender are predictors of survival in these cases.",
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N2 - Background Thoracic aortic dissection (AD) is a rare occurrence in childhood and mostly associated with connective tissue disorders or congenital abnormalities. We examined the characteristics associated with AD and predictors of survival. Methods The Kids' Inpatient Database (1997-2009) was used to identify thoracic ADs occurring in patients <20-y-old. Clinical characteristics, as well as determinants of survival, were analyzed using standard statistical methods. Results One hundred sixty-eight cases of thoracic AD were identified during the study period. Overall survival was 83%. Average length of stay was 15.9 ± 16.9 d, with charges 181,867.92 ± $211,985.00. Thoracic dissection tended to affect adolescents aged 15-19 y (67%), males (76%), and Caucasians (56%) most frequently. Most patients were privately insured (64%) and treated at urban teaching centers (86%). Commonly associated diagnoses were hypertension (18%), Marfan syndrome (15%), and aortic valve disorders (8%). When repair was performed, open repair was more frequent (88%) than endovascular repair (6%). Hemorrhage was the most common complication (19%). Multiple determinants of survival were found. Girls (mortality odds ratio: 0.21 [0.05-0.91]) fared better than boys, P = 0.023. Patients with Medicaid (2.84 [1.21-6.69]) had higher mortality versus privately insured, P = 0.014. Income, race, and hospital characteristics, and type of repair were not significant predictors, even on sub-analyses of surgical and nonsurgical groups separately. Conclusions Dissection of the thoracic aorta is a rare but significant condition affecting the pediatric population. Most repairs are performed using open technique. Payer status and gender are predictors of survival in these cases.

AB - Background Thoracic aortic dissection (AD) is a rare occurrence in childhood and mostly associated with connective tissue disorders or congenital abnormalities. We examined the characteristics associated with AD and predictors of survival. Methods The Kids' Inpatient Database (1997-2009) was used to identify thoracic ADs occurring in patients <20-y-old. Clinical characteristics, as well as determinants of survival, were analyzed using standard statistical methods. Results One hundred sixty-eight cases of thoracic AD were identified during the study period. Overall survival was 83%. Average length of stay was 15.9 ± 16.9 d, with charges 181,867.92 ± $211,985.00. Thoracic dissection tended to affect adolescents aged 15-19 y (67%), males (76%), and Caucasians (56%) most frequently. Most patients were privately insured (64%) and treated at urban teaching centers (86%). Commonly associated diagnoses were hypertension (18%), Marfan syndrome (15%), and aortic valve disorders (8%). When repair was performed, open repair was more frequent (88%) than endovascular repair (6%). Hemorrhage was the most common complication (19%). Multiple determinants of survival were found. Girls (mortality odds ratio: 0.21 [0.05-0.91]) fared better than boys, P = 0.023. Patients with Medicaid (2.84 [1.21-6.69]) had higher mortality versus privately insured, P = 0.014. Income, race, and hospital characteristics, and type of repair were not significant predictors, even on sub-analyses of surgical and nonsurgical groups separately. Conclusions Dissection of the thoracic aorta is a rare but significant condition affecting the pediatric population. Most repairs are performed using open technique. Payer status and gender are predictors of survival in these cases.

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