Health Insurance Payor Type as a Predictor of Clinical Presentation and Mortality in Patients Undergoing Urgent or Emergent TEVAR for Type B Aortic Dissection: Insights from Society for Vascular Surgery Vascular Quality Initiative Database.

BACKGROUND

Socioeconomic disparities influence access to care and outcomes across vascular surgery. Type B aortic dissection (TBAD) frequently results from uncontrolled hypertension and may present emergently in patients with limited health-care access. This study examines the impact of health-care insurance payor type as a surrogate for socioeconomic status on outcomes of nonelective (urgent/emergent) thoracic endovascular aortic repair (TEVAR) in patients with complicated TBAD. Given that TBAD often results from uncontrolled hypertension, patients with lower socioeconomic status may experience delayed diagnosis and suboptimal preventive care.

METHODS

The Society for Vascular Surgery Vascular Quality Initiative database was explored from 2011 to 2021. All patients receiving nonelective TEVAR for TBAD were included. Patients were stratified into 2 groups: group I included patients on federal or state-funded insurance programs (Medicare, Medicaid, or Medicare advantage) and group II comprised of patients on commercial insurance plans. Analysis was performed to compare the disease characteristics and postoperative outcomes between the 2 groups. A subgroup analysis was also performed within the government-insured cohort to compare outcomes between Medicare and Medicaid recipients.

RESULTS

A total of 1,862 patients were analyzed, of which 960 (51.6%) were in group I and 902 (48.4%) were categorized in group II. Patients in group I on federal or state-funded health-care insurance programs were presented with much higher rates of ruptured aorta (12.5% vs. 7.8%) and lower rates of symptomatic disease (85% vs. 88.6%) when compared to group II. Group I was also seen to have higher postoperative inhospital mortality (9.7% vs. 5.3%), 30-day (9.8% vs. 5.9%), and 1-year mortality (18% vs. 10%) when compared to group II (all P < 0.05). Group I patients were also observed to have twice the risk of postoperative spinal ischemia at discharge (5% vs. 2.4%) when compared to their counterparts. A similar trend of adverse respiratory complications (14.4% vs. 10.8%) was seen in group I.

CONCLUSION

Patients with government-funded insurance undergoing nonelective TEVAR for TBAD present with more advanced disease and experience worse outcomes compared to patients with commercial insurance coverage. These findings highlight critical health-care disparities and underscore the need for targeted strategies to improve access, chronic disease management, and postoperative care in vulnerable populations.