Key result
Patients with severe comorbidities undergoing elective endovascular aortic aneurysm repair had a higher in-hospital mortality than those with lower comorbidity (1.7% vs 0.4%; OR 1.6, 95% CI 1.2-2.2).
Why the study?
What is the in-hospital mortality rate for high-risk patients undergoing endovascular aortic aneurysm repair (EVAR) for nonruptured abdominal aortic aneurysms in the United States?
Cross-Sectional (n=65,502)
Yes
What is the in-hospital mortality rate for high-risk patients undergoing endovascular aortic aneurysm repair (EVAR) for nonruptured abdominal aortic aneurysms in the United States?
In the United States, EVAR for nonruptured abdominal aortic aneurysms is associated with low in-hospital mortality (1.7%) even in high-risk patients, challenging previous trial data that suggested prohibitive risk.
BACKGROUND: A randomized clinical trial from the United Kingdom (EVAR trial 2) comparing endovascular aortic aneurysm repair (EVAR) with no intervention found no advantage for EVAR in patients with high risk. This finding was predominantly caused by the substantial in-hospital mortality after EVAR (9%). HYPOTHESIS: The nationwide in-hospital mortality for patients with the highest risk undergoing EVAR in the United States is lower than that reported in EVAR trial 2. DESIGN: Population-based, cross-sectional study. SETTING: The 2001-2004 Nationwide Inpatient Sample. PATIENTS AND METHODS: The Nationwide Inpatient Sample identified EVAR procedures for nonruptured abdominal aortic aneurysms. Risk stratification was based on comorbidities and the Charlson comorbidity index, a validated predictor of in-hospital mortality after abdominal aortic aneurysms repairs. Weighted univariate and logistic regression analyses were used to determine the association between comorbidity measures and risk-adjusted in-hospital mortality. RESULTS: During the 4-year period, 65 502 EVARs were performed with an in-hospital mortality of 2.2%. Risk-adjusted in-hospital mortality rates ranged from 1.2% to 3.7%. Stratified analyses, including only elective EVAR procedures, revealed that in-hospital mortality was significantly higher in patients with the most severe comorbidities (1.7%) vs those with lower comorbidity (0.4%; P<.001). Patients with high risk had only a 1.6-fold increased risk of adjusted in-hospital mortality (odds ratio, 1.6; 95% confidence interval, 1.2-2.2) compared with patients with low risk. CONCLUSIONS: The EVAR procedure is currently being performed in the United States with low in-hospital mortality, even in patients with the highest risk. Therefore, EVAR should not be denied to high-risk patients with abdominal aortic aneurysms in the United States on the basis of the level I evidence from the United Kingdom study.
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Carlos H. Timaran (2007) conducted a cross-sectional in Nonruptured abdominal aortic aneurysms (n=65,502). Severe comorbidities (high risk) vs. Lower comorbidity (low risk) was evaluated on In-hospital mortality (OR 1.6, 95% CI 1.2-2.2, p=<.001). Patients with severe comorbidities undergoing elective endovascular aortic aneurysm repair had a higher in-hospital mortality than those with lower comorbidity (1.7% vs 0.4%; OR 1.6, 95% CI 1.2-2.2).
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