Readmission after Zone 3 or distal thoracic endovascular aortic repair for blunt traumatic aortic Injury and acute Type B aortic dissection: a retrospective cohort study

This study aimed to investigate the differences in the association of acute Stanford type B aortic dissection (ATBAD) and blunt thoracic aortic injury (BTAI) with readmission rates following thoracic endovascular aortic repair (TEVAR). A retrospective analysis was conducted on consecutive patients who underwent TEVAR at four medical centers from January 2014 to December 2023. A multivariable logistic regression model assessed the correlation between ATBAD or BTAI and early readmission, while a multivariable Cox regression model evaluated their association with overall readmission after TEVAR. Kaplan-Meier curves were generated to compare freedom from overall readmission rates. 443 patients were enrolled; 89 had BTAI (22.7%) and 354 had ATBAD (77.3%). Early readmission was significantly lower in BTAI patients compared to those with ATBAD (12.4% [n=11] vs 26.8% [n=95]; P=0.004, adjusted P=0.046), including stent-related readmissions which were also lower in the BTAI group (3.4% [n=3] vs 18.1% [n=64]; P=0.001, adjusted P=0.023). For early readmission of ATBAD, with odds ratio (OR) of 2.001 ([95% confidence interval (CI), 1.472-2.500], P=0.016); while after adjustment, it resulted in an OR of 1.404 ([95% CI, 0.871-1.720], adjusted P=0.125). However, an independent association was found between ATBAD and overall readmission: primary unadjusted result yielded a hazard ratio (HR) of 2.450 ([95% CI, 1.699-3.009], P =0.007); after adjustment, it resulted in a HR of 1 .802 ([95% CI, 1.386-1.960], adjusted P =0.021). This association remained consistent across subgroup analyses without significant interactions noted among subgroups. Moreover, the BTAI cohort demonstrated a higher rate of freedom from overall readmission at 83.5% (HR, 2.043 [95% CI, 1.318-3.168]; Log-rank P=0.010), and exhibited higher systolic blood pressure (with all P<0.05 of the simple effect), diastolic blood pressure (F=30.99, p<0.001), and lower left ventricular ejection fraction (F=34.02, P<0.001) during follow-up. BTAI was associated with a reduced risk of overall readmission after TEVAR; primary reasons for readmission were less stent-related and BTAI resulted in higher blood pressure and lower LVEF. Not applicable.