O-073 - TRENDS IN THE MANAGEMENT AND IN-HOSPITAL OUTCOMES OF TYPE B AORTIC DISSECTIONS ACROSS AUSTRALASIA.

TOPIC:
Thoraco-abdominal Aortic Disease
AUTHORS:
Barry I. (Fiona Stanley Hospital ~ Perth ~ Australia) , Norman P. (Fiona Stanley Hospital ~ Perth ~ Australia) , Ritter J.C. (Fiona Stanley Hospital ~ Perth ~ Australia)
Introduction:
The incidence of aortic dissection is estimated to be 7.2 to 8.8 cases per 100,00 population [1]. Management is traditionally dependent upon uncomplicated or complicated status. The aim of this study was to investigate the incidence and short term outcomes of surgical repair for type B aortic dissection (TBAD) in Australia and New Zealand. 

Methods:
Retrospective analyses of data from a bi-national (Australian and New Zealand) surgical audit registry and a national (Australia) hospital morbidity and mortality dataset. 
 Data was obtained from the Australasian Vascular Audit (AVA) and the Australian Institute of Health and Welfare (AIHW). The former is a total practice audit mandated for all members of the Australian and New Zealand Society for Vascular Surgery while the latter is an independent government agency which records all healthcare data in Australia. 
 All cases of TBAD undergoing intervention by either endovascular or open repair, between 2010 and 2019, were identified using prospectively recorded data from the AVA. The primary outcomes were temporal trends in procedures and hospital mortality; secondary outcomes were complications and risk factors for mortality. All admissions and procedures for, and hospital deaths from TBAD in Australia were identified in AIHW datasets using the relevant diagnosis and procedure codes, with age-standardised rates calculated for the period 2000-1 to 2018-19
Results:
A total of 733 cases of TBAD requiring intervention were identified (AVA data). Of these, 96.6% were treated by endovascular repair. There was an increase in the annual procedure number from 54 in 2010 to 115 in 2019. In-hospital mortality was 5.4% for endovascular repair and 32% for open repair (p <.001). From 2000-1 to 2018-9 the age-standardised procedure rates for TBAD (Australia) doubled, the proportion of admitted 
patients undergoing a procedure rose from 28% to 43%, and in-hospital deaths fell by 25%. 

Conclusion:
There has been an increasing incidence of surgical intervention for TBAD over the last 10-20 years. The majority of patients received endovascular therapy and the mortality from surgically managed TBAD appears to be falling.
References:
[1] von Allmen RS, Anjum A, Powell JT. Incidence of descending aortic pathology and 
evaluation of the impact of thoracic endovascular aortic repair: a population-based study in 
England and Wales from 1999 to 2010. Eur J Vasc Endovasc Surg 2013; 45: 154-9. 
doi: 10.1016/j.ejvs.2012.12.007.