Burden and causes of readmissions following initial discharge after aortic syndromes

Abstract Introduction Aortic syndromes (AS), including aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU), carry significant morbidity and mortality; little data exist regarding burden and causes of related rehospitalizations following initial discharge. Methods The study was conducted using the Rochester Epidemiology Project (REP). All adult residents (age≥18 years) with an incident diagnosis of AD/IMH/PAU (1995-2015) were identified from the REP using the International Classification of Disease (ICD), 9th and 10th revision, codes and Hospital Adaptation of the ICD, 2nd edition, codes. Assessment of any-cause (aortic+cardiovascular), aortic-related, or cardiovascular-related readmissions was determined following date of hospital discharge or diagnosis date (i.e. the index event). Results A total of 117 patients out of 130 cases of AD/IMH/PAU included in the initial study population survived the index event and were evaluated. The median age of diagnosis was 74 years and 70 (60%) were male. A total of 79 patients (68%) experienced at least one readmission. The median time to first any-cause, cardiovascular and aortic readmission was 143, 861 and 171 days, respectively. The cumulative incidence of any-cause readmissions at 2, 4 and 10 years was 45%, 55% and 69%, respectively. The cumulative incidence of cardiovascular readmissions at 2, 4 and 10 years was 15%, 20% and 28%, respectively. The cumulative incidence of aortic readmissions at 2, 4 and 10 years was 38%, 46% and 59%, respectively. Overall survival for the entire cohort at 2, 4 and 10 years was 84%, 75% and 50%, respectively. Conclusion Readmissions following initial discharge after diagnosis of AS are common and not different across specific disease types. While aortic-related rehospitalization occur in more than half of patients but tend to be earlier, cardiovascular-related rehospitalizations tend to happen later in about one third of subjects. This may suggest the need for early follow-up focused on aortic complications while later follow-up should address cardiovascular events.