Hospital Incidence and In-Hospital Mortality of Surgically and Interventionally Treated Aortic Dissections: Secondary Data Analysis of the Nationwide German Diagnosis-Related Group Statistics From 2006 to 2014

Background-Population-based data about the incidence and mortality of patients with aortic dissections (ADs) are sparse. Therefore, the hospital incidence and in-hospital mortality of patients undergoing open or endovascular surgery for type A ADs (TAADs) and type B ADs (TBADs) in Germany were analyzed on a nationwide basis between 2006 and 2014. Methods and Results-A secondary data analysis of the nationwide diagnosis-related group statistics, compiled by the German Federal Statistical Office, was performed for patients who were surgically/interventionally treated for AD (International Classification of Diseases, Tenth Revision, German Modification [ICD-10-GM] codes 171.00-171.07; n=20 533). By using specific procedure codes, a distinction between TAAD (n=14 911/72.6%) and TBAD (n=5622/27.4%) could be made. The standardized hospital incidence of surgically/interventionally treated AD was 2.7 / 100 000 per year, comprising 2.0/100 000 per year for TAAD and 0.7 / 100 000 per year for TBAD. The in-hospital mortality of TAAD was 19.5%; and of TBAD, 9.3%. Both the incidence and in-hospital mortality increased over the 9-year period. The share of endovascularly treated TBAD increased steadily during the same time interval. A multilevel multivariable analysis revealed that, for TAAD, age and comorbidity were significantly associated with a higher mortality risk.The latter was also true for TBAD. Sex was not significantly associated with mortality. A significant association between higher annual center volume and mortality was found for TAAD, but not for TBAD. Conclusions-This is the first report on hospital incidence and mortality for surgically/interventionally treated AD on a nationwide basis. Overall, in Germany, hospital incidence and mortality of TAAD and TBAD increased over time. In addition, TAAD is performed more safely in high-volume centers.