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Comparative Study
. 2014 Mar;59(3):575-82.
doi: 10.1016/j.jvs.2013.08.093. Epub 2013 Dec 15.

Comparative effectiveness of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Medicare population

Samuel T Edwards  1 , Marc L Schermerhorn  2 , A James O'Malley  3 , Rodney P Bensley  2 , Rob Hurks  4 , Philip Cotterill  5 , Bruce E Landon  6
Affiliations
Comparative Study

Comparative effectiveness of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Medicare population

Samuel T Edwards et al. J Vasc Surg. 2014 Mar.

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.

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Figures

Appendix Figure 1
Appendix Figure 1
Cohort formation and determination of treatment type
Appendix Figure 2
Appendix Figure 2
Mortality of unmatched patients undergoing endovascular and open repair of ruptured aortic aneurysm. Overall and stratified by age.
Figure 1
Figure 1
Mortality of propensity matched patients undergoing endovascular and open repair of ruptured aortic aneurysm. Overall and stratified by age.
Figure 2
Figure 2
Trends in rAAA treatment, and 30 day mortality by treatment type 2001–2008
See this image and copyright information in PMC

References

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