Presentation (CTI)

OBJECTIVES: To develop and evaluate a reproducible methodology for quantifying the organisational and healthcare utilisation burden across complex thoracic aortic repair pathways by using real-world data.
METHODS: NHS England Health Episode Statistics (HES) admitted patient care data from financial years 2020/21-2024/25 were analysed retrospectively. ICD-10 diagnosis codes and linked OPCS procedural codes were used to identify patients who had undergone thoracic aortic intervention for aneurysm or dissection. Coding algorithms were developed to identify TEVAR pathways involving adjunctive LSA revascularisation, anatomical complexity and exclusion of branched endovascular repair. Outcomes included critical care utilisation, critical care share of stay and hospital length of stay (LOS).
RESULTS: TEVAR involving adjunctive LSA revascularisation was associated with higher average critical care utilisation (5.8 vs 4.9 days) and a greater share of critical care stays (28.2% vs 18.5%) compared to TEVAR alone. Although mean LOS was similar between cohorts (17.9 vs 20.2 days), median LOS was higher in pathways involving adjunctive LSA revascularisation than with TEVAR alone (10 vs 9 days, respectively). Differences in upper quartile LOS were also observed over the years studied - most notably in 2022/23, when median and third quartile bed days were substantially higher in the LSA revascularisation cohort compared with TEVAR alone (31 vs 9 days and 45 vs 19 days, respectively), suggesting increased resource intensity among higher-complexity patients.
CONCLUSIONS: This study demonstrates the feasibility of using real-world NHS data to quantify differences in organisational and healthcare utilisation burden across complex thoracic aortic repair pathways. The proposed framework may support future economic evaluations, provider-level resource planning, and comparative assessment of evolving endovascular treatment pathways within NHS practice.