Aortic Surgery Outcomes of Marfan Syndrome and Ehlers-Danlos Syndrome Patients at Teaching and Non-Teaching Hospitals.

OBJECTIVE: Despite improvements in prevention and management, aortic aneurysm repair remains a high risk operation for patients with Marfan syndrome (MFS) and Ehlers-Danlos syndrome (EDS). The goal of this study was to examine differences in characteristics and outcomes of patients with MFS or EDS undergoing aortic aneurysm repair at teaching versus non-teaching hospitals.

METHODS: We used the National Inpatient Sample to study patients with MFS or EDS undergoing open or endovascular aortic aneurysm repair from 2000 to 2014.

RESULTS: Of 3487 patients (MFS=3375, EDS=112), 2974 (85%) had repair at a teaching hospital. Patients who underwent repair at a teaching hospital were slightly younger than those who underwent repair at a non-teaching hospital (38 vs 43 years, p<0.01) but otherwise were similar in gender (29% vs 28% female), race (70% vs 78% white), and connective tissue disorder diagnosis (97% vs 97% MFS, all p≥0.1). There were no differences in anatomy (17% vs 19% abdominal, 67% vs. 66% thoracic, and 15% vs 15% thoracoabdominal, all p≥0.1) or type of repair (5% vs 5% endovascular), but patients at non-teaching hospitals were more likely to have a dissection (49% vs. 38%, p=0.02). There was no difference in perioperative mortality (4% vs 6%, p=0.5) or length of stay (median 8 days vs. 7 days, p=0.3) between teaching and non-teaching hospitals. There was also no difference in hemorrhagic (47% vs 43%), pulmonary (9% vs 16%), renal (12% vs 14%), or neurologic (5% vs 6%) complications between teaching and non-teaching hospitals respectively (all p≥0.05). In analysis stratified by anatomic extent of repair, there was a lower prevalence of pulmonary complications in thoracic aorta repairs at teaching hospitals (8.1% vs. 18.4%, p=0.01) but a higher prevalence of hemorrhage in abdominal aortic repairs at teaching hospitals (45.6% vs. 20.6%, p=0.04) as compared to non-teaching hospitals.

CONCLUSION: Marfan and Ehlers-Danlos syndrome patients who undergo aortic aneurysm repair have their operations predominantly at teaching hospitals, but those patients who undergo repair at non-teaching hospitals do not have worse mortality or morbidity despite a higher incidence of dissection.