Hospital incidence, treatment and mortality of traumatic aortic injury in German hospitals.

Abstract

Background: Blunt thoracic aortic injury (BTAI) is a life-threatening condition. Comprehensive nationwide data from European healthcare systems are limited. This study aims to analyse temporal trends in hospital incidence, treatment strategies, and outcomes of BTAI in Germany. Materials and methods: This retrospective secondary analysis used nationwide German Diagnosis-Related-Groups hospital episode statistics. All BTAI cases between 2010 and 2023 were included. Treatment strategies were classified as open repair, endovascular repair or conservative management based on Operations and Procedures Classification codes. Primary outcome was in-hospital mortality. Adjusted multivariable logistic regression was performed. Age, sex, Elixhauser comorbidity score, treatment modality, treatment period, and treatment in a vascular surgery department were included in the statistical model. Results: In total 3,530 cases were identified (Mdn_age 58 years; 70.1% male). TEVAR was performed in 30.5%, open repair in 16.4%, and 53.1% were managed conservatively. Overall, in-hospital mortality was 24.4% (16.0% after endo, 25.8% after open repair and 28.7% in not-treated cases). Increasing age (adjusted odds ratio [aOR] 1.12 per 10 years, 95% Confidence interval [CI] 1.07-1.17) and higher comorbidity burden (aOR 1.03 per point, CI 1.02-1.04) were independently associated with mortality. Both endo (aOR 0.55, CI 0.44-0.68) and open repair (aOR 0.69, CI 0.54-0.89) were associated with lower mortality compared with conservative management. Conclusions: In Germany, BTAI hospital incidence showed temporal variation with pandemic-related decline. Endovascular repair was the predominant active treatment and was associated with lower in-hospital mortality. Outcomes were strongly influenced by age, comorbidity, and specialised vascular care.