Association of Non-infectious Aortitis With Acute Outcomes of Open Thoracic Aortic Aneurysm Repair

Abstract

Background: Non-infectious aortitis is encountered in a meaningful subset of patients undergoing open thoracic aortic aneurysm repair (TAAR) and may plausibly worsen perioperative risk through inflammatory tissue friability, impaired wound integrity, and systemic immune dysregulation. Prior perioperative evidence is largely derived from single-center series with limited sample sizes, leaving uncertainty regarding whether aortitis independently confers excess early mortality, morbidity, or resource utilization after open repair. Methods: All adults undergoing open TAAR were identified from the 2016-2022 Nationwide Readmissions Database and stratified by concomitant aortitis diagnosis. Following LASSO-guided variable selection, multivariable regression models were developed to examine the association between aortitis and outcomes of interest. Results: Of an estimated 88,938 patients, 4,404 (5.0%) had non-infectious aortitis. Patients with aortitis were older (69 vs 63 years), more frequently female (36.3 vs 28.0%), and exhibited greater comorbidity burden and frailty prevalence (all P < .001). Following multivariable adjustment, aortitis was independently associated with increased odds of in-hospital mortality (AOR: 1.45, 95% CI: 1.14-1.84), major adverse cardiac and cerebrovascular events (AOR: 1.40, 95% CI: 1.15-1.70), neurologic complications (AOR: 1.33, 95% CI: 1.05-1.70), and nonhome discharge (AOR: 1.38, 95% CI: 1.19-1.60). Aortitis was further linked with $6,790 in additional hospitalization costs (95% CI: $4,100–$9,470). Discussion: Aortitis is independently associated with increased perioperative mortality, morbidity, and resource utilization following open TAAR. The elective nature of most repairs in this population provides an opportunity for regionalization to high-volume aortic centers with expertise in managing inflammatory aortic pathology. Future studies should explore preoperative optimization strategies for this vulnerable population.