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Comparative effectiveness of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Medicare population.
J Vasc Surg. 2014 Mar; 59(3):575-82.JV

Abstract

OBJECTIVE

Endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) is increasingly used for emergent treatment of ruptured AAA (rAAA). We sought to compare the perioperative and long-term mortality, procedure-related complications, and rates of reintervention of EVAR vs open aortic repair of rAAA in Medicare beneficiaries.

METHODS

We examined perioperative and long-term mortality and complications after EVAR or open aortic repair performed for rAAA in all traditional Medicare beneficiaries discharged from a United States hospital from 2001 to 2008. Patients were matched by propensity score on baseline demographics, coexisting conditions, admission source, and hospital volume of rAAA repair. Sensitivity analyses were performed to evaluate the effect of bias that might have resulted from unmeasured confounders.

RESULTS

Of 10,998 patients with repaired rAAA, 1126 underwent EVAR and 9872 underwent open repair. Propensity score matching yielded 1099 patient pairs. The average age was 78 years, and 72.4% were male. Perioperative mortality was 33.8% for EVAR and 47.7% for open repair (P < .001), and this difference persisted for >4 years. At 36 months, EVAR patients had higher rates of AAA-related reinterventions than open repair patients (endovascular reintervention, 10.9% vs 1.5%; P < .001), whereas open patients had more laparotomy-related complications (incisional hernia repair, 1.8% vs 6.2%; P < .001; all surgical complications, 4.4% vs 9.1%; P < .001). Use of EVAR for rAAA increased from 6% of cases in 2001 to 31% in 2008, whereas during the same interval, overall 30-day mortality for admission for rAAA, regardless of treatment, decreased from 55.8% to 50.9%.

CONCLUSIONS

EVAR for rAAA is associated with lower perioperative and long-term mortality in Medicare beneficiaries. Increasing adoption of EVAR for rAAA is associated with an overall decrease in mortality of patients hospitalized for rAAA during the last decade.

Authors+Show Affiliations

Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass.Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.Department of Health Care Policy, Harvard Medical School, Boston, Mass.Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Mass; Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.Centers for Medicare and Medicaid Services, Baltimore, Md.Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass; Department of Health Care Policy, Harvard Medical School, Boston, Mass. Electronic address: landon@hcp.med.harvard.edu.

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

24342064

Citation

Edwards, Samuel T., et al. "Comparative Effectiveness of Endovascular Versus Open Repair of Ruptured Abdominal Aortic Aneurysm in the Medicare Population." Journal of Vascular Surgery, vol. 59, no. 3, 2014, pp. 575-82.
Edwards ST, Schermerhorn ML, O'Malley AJ, et al. Comparative effectiveness of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Medicare population. J Vasc Surg. 2014;59(3):575-82.
Edwards, S. T., Schermerhorn, M. L., O'Malley, A. J., Bensley, R. P., Hurks, R., Cotterill, P., & Landon, B. E. (2014). Comparative effectiveness of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Medicare population. Journal of Vascular Surgery, 59(3), 575-82. https://doi.org/10.1016/j.jvs.2013.08.093
Edwards ST, et al. Comparative Effectiveness of Endovascular Versus Open Repair of Ruptured Abdominal Aortic Aneurysm in the Medicare Population. J Vasc Surg. 2014;59(3):575-82. PubMed PMID: 24342064.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative effectiveness of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Medicare population. AU - Edwards,Samuel T, AU - Schermerhorn,Marc L, AU - O'Malley,A James, AU - Bensley,Rodney P, AU - Hurks,Rob, AU - Cotterill,Philip, AU - Landon,Bruce E, Y1 - 2013/12/15/ PY - 2013/05/14/received PY - 2013/08/20/revised PY - 2013/08/22/accepted PY - 2013/12/18/entrez PY - 2013/12/18/pubmed PY - 2014/4/29/medline SP - 575 EP - 82 JF - Journal of vascular surgery JO - J Vasc Surg VL - 59 IS - 3 N2 - OBJECTIVE: Endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) is increasingly used for emergent treatment of ruptured AAA (rAAA). We sought to compare the perioperative and long-term mortality, procedure-related complications, and rates of reintervention of EVAR vs open aortic repair of rAAA in Medicare beneficiaries. METHODS: We examined perioperative and long-term mortality and complications after EVAR or open aortic repair performed for rAAA in all traditional Medicare beneficiaries discharged from a United States hospital from 2001 to 2008. Patients were matched by propensity score on baseline demographics, coexisting conditions, admission source, and hospital volume of rAAA repair. Sensitivity analyses were performed to evaluate the effect of bias that might have resulted from unmeasured confounders. RESULTS: Of 10,998 patients with repaired rAAA, 1126 underwent EVAR and 9872 underwent open repair. Propensity score matching yielded 1099 patient pairs. The average age was 78 years, and 72.4% were male. Perioperative mortality was 33.8% for EVAR and 47.7% for open repair (P < .001), and this difference persisted for >4 years. At 36 months, EVAR patients had higher rates of AAA-related reinterventions than open repair patients (endovascular reintervention, 10.9% vs 1.5%; P < .001), whereas open patients had more laparotomy-related complications (incisional hernia repair, 1.8% vs 6.2%; P < .001; all surgical complications, 4.4% vs 9.1%; P < .001). Use of EVAR for rAAA increased from 6% of cases in 2001 to 31% in 2008, whereas during the same interval, overall 30-day mortality for admission for rAAA, regardless of treatment, decreased from 55.8% to 50.9%. CONCLUSIONS: EVAR for rAAA is associated with lower perioperative and long-term mortality in Medicare beneficiaries. Increasing adoption of EVAR for rAAA is associated with an overall decrease in mortality of patients hospitalized for rAAA during the last decade. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/24342064/Comparative_effectiveness_of_endovascular_versus_open_repair_of_ruptured_abdominal_aortic_aneurysm_in_the_Medicare_population_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(13)01693-5 DB - PRIME DP - Unbound Medicine ER -