{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T09:39:54Z","timestamp":1780047594357,"version":"3.53.1"},"reference-count":13,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thorac Cardiovasc Surg"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Although insurance status has been linked to surgical outcomes in thoracic aortic operations, its specific association with the outcomes of Type A Aortic Dissection (TAAD) repair remains underexplored. This study aimed to conduct a comprehensive, population-based analysis to assess the association between insurance status and in-hospital outcomes after TAAD repair using a national registry.<\/jats:p><jats:p>Patients who underwent TAAD repair were identified in National Inpatient Sample from the last quarter of 2015 to 2020. Multivariable logistic regressions were used to compare in-hospital outcomes between patients using public and private insurance while adjusting for demographics, comorbidities, hospital characteristics, primary payer status, and transfer-in status.<\/jats:p><jats:p>There were 2,380 (55.58%) and 1,468 (34.28%) patients under public and private insurance, respectively. Patients under public and private insurance had comparable time from admission to operation (p\u2009=\u20090.08) and adjusted in-hospital mortality rates (aOR\u2009=\u20091.172, 95 CI\u2009=\u20090.925\u20131.484, p\u2009=\u20090.19). However, patients under public insurance had higher mechanical ventilation (aOR\u2009=\u20091.185, 95 CI\u2009=\u20091.024\u20131.373, p\u2009=\u20090.02), acute kidney injury (aOR\u2009=\u20091.213, 95 CI\u2009=\u20091.052\u20131.399, p\u2009=\u20090.01), and infection (aOR\u2009=\u20091.428, 95 CI\u2009=\u20091.087\u20131.876, p\u2009=\u20090.01). Moreover, patients under public insurance had higher transfer-out rate (p\u2009&lt;\u20090.01), longer length of stay (p\u2009&lt;\u20090.01), and higher total hospital charge (p\u2009&lt;\u20090.01).<\/jats:p><jats:p>Although patients with public insurance had comparable adjusted mortality outcomes to those of privately insured patients, they experienced higher rates of postoperative complications and resource utilization. Future studies should investigate the underlying systemic reasons for these disparities and explore strategies for improving surgical outcomes and ensuring equitable healthcare delivery for these vulnerable populations.<\/jats:p>","DOI":"10.1055\/a-2531-3208","type":"journal-article","created":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T18:54:12Z","timestamp":1740423252000},"page":"486-492","source":"Crossref","is-referenced-by-count":1,"title":["Insurance and In-hospital Outcomes of Type A Aortic Dissection Repair: A Population Study of National Inpatient Sample from 2015\u20132020"],"prefix":"10.1055","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1691-6278","authenticated-orcid":false,"given":"Renxi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Huddleston","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,2,24]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1016\/j.jvs.2019.11.013","article-title":"Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections","volume":"71","author":"J V Lombardi","year":"2020","journal-title":"J Vasc Surg"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/S0003-4975(10)65594-4","article-title":"Management of acute aortic dissections","volume":"10","author":"P O Daily","year":"1970","journal-title":"Ann Thorac 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Surg"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"S1848","DOI":"10.1016\/S0003-4975(02)04128-0","article-title":"Advances in the treatment of acute type A dissection: an integrated approach","volume":"74","author":"J E Bavaria","year":"2002","journal-title":"Ann Thorac Surg"},{"issue":"25","key":"ref7","doi-asserted-by":"crossref","first-page":"1903","DOI":"10.1161\/CIRCULATIONAHA.122.061065","article-title":"Clinical characteristics, incidences, and mortality rates for type A and B aortic dissections: a nationwide Danish population-based cohort study from 1996 to 2016","volume":"146","author":"L M Obel","year":"2022","journal-title":"Circulation"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.jtcvs.2004.09.005","article-title":"Contemporary results of surgery in acute type A aortic dissection: the International Registry of Acute Aortic Dissection experience","volume":"129","author":"S Trimarchi","year":"2005","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"10","key":"ref9","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1001\/jamacardio.2022.2718","article-title":"Early mortality in type A acute aortic dissection: insights from the International Registry of Acute Aortic Dissection","volume":"7","author":"K M Harris","year":"2022","journal-title":"JAMA Cardiol"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1161\/CIRCOUTCOMES.113.000593","article-title":"Insurance status is associated with acuity of presentation and outcomes for thoracic aortic operations","volume":"7","author":"N D Andersen","year":"2014","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1097\/SLA.0b013e3181e8fd75","article-title":"Primary payer status affects mortality for major surgical operations","volume":"252","author":"D J LaPar","year":"2010","journal-title":"Ann Surg"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/00005650-199801000-00004","article-title":"Comorbidity measures for use with administrative data","volume":"36","author":"A Elixhauser","year":"1998","journal-title":"Med Care"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/j.jss.2024.04.081","article-title":"Low socioeconomic status is associated with higher in-hospital mortality in Stanford Type A Aortic Dissection repair: a population study of national inpatient sample from 2015 to 2020","volume":"300","author":"R Li","year":"2024","journal-title":"J Surg Res"}],"container-title":["The Thoracic and Cardiovascular Surgeon"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2531-3208.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T22:43:49Z","timestamp":1756853029000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2531-3208"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,24]]},"references-count":13,"journal-issue":{"issue":"06","published-online":{"date-parts":[[2025,9,2]]},"published-print":{"date-parts":[[2025,9]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2531-3208","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0171-6425","1439-1902"],"issn-type":[{"value":"0171-6425","type":"print"},{"value":"1439-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,24]]}}}