Key result
Endovascular repair for ruptured abdominal aortic aneurysm was associated with lower in-hospital mortality compared to open surgical repair (OSAR vs EVAR OR 1.95; 95% CI 1.74-2.18).
Why the study?
Does endovascular repair reduce mortality and complications compared to open surgical repair in patients with ruptured abdominal aortic aneurysms?
Cohort (n=8,480)
Yes
Does endovascular repair reduce mortality and complications compared to open surgical repair in patients with ruptured abdominal aortic aneurysms?
In a nationwide Medicare cohort, endovascular repair of ruptured abdominal aortic aneurysms was associated with significantly lower in-hospital mortality, fewer complications, and shorter length of stay compared to open surgical repair.
Answers are grounded in this paper and cite their sources.
May support EVAR preference in ruptured AAA; leaves open need for randomized confirmation.
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.
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Tremont et al. (2016) conducted a cohort in Ruptured abdominal aortic aneurysm (rAAA) (n=8,480). Endovascular repair (EVAR) vs. Open surgical repair (OSAR) was evaluated on In-hospital mortality (OR 1.95, 95% CI 1.74-2.18). Endovascular repair for ruptured abdominal aortic aneurysm was associated with lower in-hospital mortality compared to open surgical repair (OSAR vs EVAR OR 1.95; 95% CI 1.74-2.18).
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