Raja R. Gopaldas

Superior nationwide outcomes of endovascular versus open repair for isolated descending thoracic aortic aneurysm in 11,669 patients

OBJECTIVESnThoracic endovascular aneurysm repair (TEVAR) was introduced in 2005 to treat descending thoracic aortic aneurysms. Little is known about TEVARs nationwide effect on patient outcomes. We evaluated nationwide data regarding the short-term outcomes of TEVAR and open aortic repair (OAR) procedures performed in the United States during a 2-year period.nnnMETHODSnFrom the Nationwide Inpatient Sample data, we identified patients who had undergone surgery for an isolated descending thoracic aortic aneurysm from 2006 to 2007. Patients with aneurysm rupture, aortic dissection, vasculitis, connective tissue disorders, or concomitant aneurysms in other aortic segments were excluded. Of the remaining 11,669 patients, 9106 had undergone conventional OAR and 2563 had undergone TEVAR. Hierarchic regression analysis was used to assess the effect of TEVAR versus OAR after adjusting for confounding factors. The primary outcomes were mortality and the hospital length of stay (LOS). The secondary outcomes were the discharge status, morbidity, and hospital charges.nnnRESULTSnThe patients who had undergone TEVAR were older (69.5xa0± 12.7 vs 60.2xa0± 14.2 years; Pxa0<xa0.001) and had higher Deyo comorbidity scores (4.6xa0± 1.8 vs 3.3xa0± 1.8; Pxa0<xa0.001). The unadjusted LOS was shorter for the TEVAR patients (7.7xa0± 11 vs 8.8xa0± 7.9 days), but the unadjusted mortality was similar (TEVAR 2.3% vs OAR 2.3%; Pxa0=xa01.0). The proportion of nonelective interventions was similar between the 2 groups (TEVAR 15.9% vs OAR 15.8%; Pxa0=xa0.9). The TEVAR and OAR techniques produced similar risk-adjusted mortality rates; however, the TEVAR patients had 60% fewer complications overall (odds ratio, 0.39; Pxa0<xa0.001) and a shorter LOS (by 1.3 days). The TEVAR patients hospital charges were greater by

Video-Assisted Thoracoscopic Versus Open Thoracotomy Lobectomy in a Cohort of 13,619 Patients

6713 (95% confidence interval

Staged Versus Synchronous Carotid Endarterectomy and Coronary Artery Bypass Grafting: Analysis of 10-Year Nationwide Outcomes

1869 to

Endovascular versus open repair of ruptured descending thoracic aortic aneurysms: A nationwide risk-adjusted study of 923 patients

11,556; Pxa0<xa0.001). However, the TEVAR patients were 4 times more likely to have a routine discharge to home.nnnCONCLUSIONSnThe nationwide data on TEVAR for descending thoracic aortic aneurysms have associated this procedure with better in-hospital outcomes than OAR, even though TEVAR was selectively performed in patients who were almost 1 decade older than the OAR patients. Compared with OAR, TEVAR was associated with a shorter hospital LOS and fewer complications but significantly greater hospital charges.

Impact of ACGME work-hour restrictions on the outcomes of coronary artery bypass grafting in a cohort of 600,000 patients.

BACKGROUNDnVideo-assisted thoracoscopic surgery (VATS) is becoming increasingly popular for lung resection in some centers. However, the issue of whether VATS or open thoracotomy is better remains controversial. We compared outcomes of open and VATS lobectomy in a national database.nnnMETHODSnUsing the 2004 and 2006 Nationwide Inpatient Sample database, we identified 13,619 discharge records of patients who underwent pulmonary lobectomy by means of thoracotomy (n = 12,860) or VATS (n = 759). Students t and chi(2) tests were used to compare the two groups. Multivariable analysis was used to identify independent predictors of outcome measures.nnnRESULTSnThe two groups of patients had similar demographics and preoperative comorbidities. They also had similar in-hospital mortality rates (3.1% versus 3.4%; p = 0.67); lengths of stay (9.3 +/- 0.1 versus 9.2 +/- 0.4 days; p = 0.84); hospitalization costs (

Severe aortic stenosis in a veteran population: treatment considerations and survival.

23,862 +/-

Clinical depression, posttraumatic stress disorder, and comorbid depression and posttraumatic stress disorder as risk factors for in-hospital mortality after coronary artery bypass grafting surgery

206 versus

Randomized controlled trial of brief cognitive behavioral intervention for depression and anxiety symptoms preoperatively in patients undergoing coronary artery bypass graft surgery

25,125 +/-

Predictors of surgical mortality and discharge status after coronary artery bypass grafting in patients 80 years and older.

1,093; p = 0.16); and rates of wound infection (0.8% versus 1.3%; p = 0.15), pulmonary complications (32.2% versus 31.2%; p = 0.55), and cardiovascular complications (3.4% versus 3.9%; p = 0.43). However, multivariable analysis showed that the VATS group had a significantly higher incidence of intraoperative complications than the thoracotomy group (odds ratio, 1.6; 95% confidence interval, 1.0 to 2.4; p = 0.04). A higher percentage of patients with annual income greater than

Predictors of in-hospital complications after pericardiectomy: A nationwide outcomes study

59,000 underwent VATS lobectomy than patients with income less than