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Endovascular Repair for Ruptured Abdominal Aortic Aneurysms has Improved Outcomes Compared to Open Surgical Repair.
Vasc Endovascular Surg. 2016 Apr; 50(3):147-55.VE

Abstract

INTRODUCTION

Ruptured abdominal aortic aneurysm (rAAA) remains a critical diagnosis, and research is needed to address outcomes following surgical repair. The purpose of this study was to compare nationwide outcomes for patients who received either endovascular repair (EVAR) or open surgical repair (OSAR) for rAAA.

METHODS

The Medicare Provider Analysis and Review file from 2005 to 2009 was used to identify patients diagnosed with rAAA and treated with either EVAR or OSAR. Those patients with both procedures were excluded. Primary outcomes included mortality, postoperative complications, and readmission rates. Secondary outcomes included hospital resource utilization and length of stay (LOS).

RESULTS

A total of 8480 patients with rAAA who underwent EVAR (n = 1939) or OSAR (n = 6541) were identified. On multivariate regression, the likelihood of dying in the hospital after OSAR compared to EVAR was significantly greater (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.74-2.18). There was significantly greater frequency of postoperative complications after OSAR compared to EVAR (OR = 2.1, 95%CI = 1.86-2.37, P < .0001). Freedom from readmission after OSAR was significantly greater than that after EVAR. Total hospital cost for all services after EVAR was greater than that after OSAR (US$100 875 vs US$89 035; P < .0001), but intensive care unit (ICU) cost for EVAR was significantly less than that for OSAR (US$5516 vs US$8600; P < .0001). Total hospital and ICU LOS were shorter in EVAR compared to OSAR (P < .0001 for both).

DISCUSSION

EVAR for rAAA has shown mortality benefits over OSAR as well as reduced ICU and total LOS. This data suggest EVAR is associated with a greater survival benefit, fewer postoperative complications, and may help improve hospital resource utilization.

Authors+Show Affiliations

Division of Vascular Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA porteljn@rwjms.rutgers.edu.Division of Vascular Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.Division of Vascular Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.Division of Vascular Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

26975604

Citation

Portelli Tremont, Jaclyn N., et al. "Endovascular Repair for Ruptured Abdominal Aortic Aneurysms Has Improved Outcomes Compared to Open Surgical Repair." Vascular and Endovascular Surgery, vol. 50, no. 3, 2016, pp. 147-55.
Portelli Tremont JN, Cha A, Dombrovskiy VY, et al. Endovascular Repair for Ruptured Abdominal Aortic Aneurysms has Improved Outcomes Compared to Open Surgical Repair. Vasc Endovascular Surg. 2016;50(3):147-55.
Portelli Tremont, J. N., Cha, A., Dombrovskiy, V. Y., & Rahimi, S. A. (2016). Endovascular Repair for Ruptured Abdominal Aortic Aneurysms has Improved Outcomes Compared to Open Surgical Repair. Vascular and Endovascular Surgery, 50(3), 147-55. https://doi.org/10.1177/1538574416637442
Portelli Tremont JN, et al. Endovascular Repair for Ruptured Abdominal Aortic Aneurysms Has Improved Outcomes Compared to Open Surgical Repair. Vasc Endovascular Surg. 2016;50(3):147-55. PubMed PMID: 26975604.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endovascular Repair for Ruptured Abdominal Aortic Aneurysms has Improved Outcomes Compared to Open Surgical Repair. AU - Portelli Tremont,Jaclyn N, AU - Cha,Andrew, AU - Dombrovskiy,Viktor Y, AU - Rahimi,Saum A, Y1 - 2016/03/13/ PY - 2016/3/16/entrez PY - 2016/3/16/pubmed PY - 2017/2/22/medline KW - cost analysis KW - endovascular aneurysm repair KW - mortality KW - outcomes KW - rAAA KW - ruptured abdominal aortic aneurysm SP - 147 EP - 55 JF - Vascular and endovascular surgery JO - Vasc Endovascular Surg VL - 50 IS - 3 N2 - INTRODUCTION: Ruptured abdominal aortic aneurysm (rAAA) remains a critical diagnosis, and research is needed to address outcomes following surgical repair. The purpose of this study was to compare nationwide outcomes for patients who received either endovascular repair (EVAR) or open surgical repair (OSAR) for rAAA. METHODS: The Medicare Provider Analysis and Review file from 2005 to 2009 was used to identify patients diagnosed with rAAA and treated with either EVAR or OSAR. Those patients with both procedures were excluded. Primary outcomes included mortality, postoperative complications, and readmission rates. Secondary outcomes included hospital resource utilization and length of stay (LOS). RESULTS: A total of 8480 patients with rAAA who underwent EVAR (n = 1939) or OSAR (n = 6541) were identified. On multivariate regression, the likelihood of dying in the hospital after OSAR compared to EVAR was significantly greater (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.74-2.18). There was significantly greater frequency of postoperative complications after OSAR compared to EVAR (OR = 2.1, 95%CI = 1.86-2.37, P < .0001). Freedom from readmission after OSAR was significantly greater than that after EVAR. Total hospital cost for all services after EVAR was greater than that after OSAR (US$100 875 vs US$89 035; P < .0001), but intensive care unit (ICU) cost for EVAR was significantly less than that for OSAR (US$5516 vs US$8600; P < .0001). Total hospital and ICU LOS were shorter in EVAR compared to OSAR (P < .0001 for both). DISCUSSION: EVAR for rAAA has shown mortality benefits over OSAR as well as reduced ICU and total LOS. This data suggest EVAR is associated with a greater survival benefit, fewer postoperative complications, and may help improve hospital resource utilization. SN - 1938-9116 UR - https://www.unboundmedicine.com/medline/citation/26975604/Endovascular_Repair_for_Ruptured_Abdominal_Aortic_Aneurysms_has_Improved_Outcomes_Compared_to_Open_Surgical_Repair_ DB - PRIME DP - Unbound Medicine ER -