Older patients with ruptured aneurysms more likely to get EVAR than open repair

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A US-based comparison of the outcome parameters associated with endovascular repair (EVAR) and open repair in the emergency setting (for ruptured abdominal aortic aneurysm) from 2001–2009 found that older patients with ruptured aneurysms were more likely to receive EVAR than open repair.

The national level study, published in the Journal of Vascular and Interventional Radiology (JVIR) in March, also found that in the emergency setting the in-hospital mortality and length of hospital stay associated with EVAR was significantly better than with open repair.
 

The authors, Prasoon Mohan, Department of Diagnostic and Interventional Radiology, St Francis Hospital, USA, and colleagues wrote that “[A] Higher proportion of patients were discharged home after EVAR than open repair. There was no significant difference in the total hospital charges associated with both procedures. Women had higher mortality compared to men regardless of the procedure.”


Investigators searched the National Inpatient Sample from the Healthcare Cost and Utilization Project for cases with ICD-9-CM code  (the official system of assigning codes to diagnoses and procedures associated with hospital utilisation in the United States) for ruptured abdominal aortic aneurysm and codes for EVAR or open repair from 2001 to 2009. They clarified that the National Inpatient Sample is the largest all payer national database containing more than 8 million discharges per year. They then used independent sample T test for statistical analysis of continuous variables and Chi-square test for categorical variables.

The investigators found that from 2001–2009, a total of 38858 patients with ruptured abdominal aortic aneurysm underwent either EVAR or open repair. There were 6790 (17.5%) EVAR procedures and 32069 (82.5%) open repairs. The average age of the EVAR cohort was 74.2 years (standard deviation 9.8) and that of open repair was 72.8 years (standard deviation 9.1) (p<0.001). The in-hospital mortality rate for EVAR was 28.2% vs. 39.7% for open repair  (p<0.001).

 

The mean length of hospital stay for EVAR was 10.7 days (standard deviation 13.4) versus 13.8 days (SD15.5) for open repair (p<0.001). The mean total hospital charges for EVAR was US$136147 (standard deviation 139311) and that for open repair was US$133074 (standard deviation 155132) (p=0.13). Following the procedure, 35.2% of those who had EVAR were discharged home vs. 21.7% of those who had open repair (p<0.001), while the rest were discharged to care facilities for further rehabilitation. Regardless of the mode of treatment, women had a higher rate of in-hospital mortality (Open repair in men had a 37.5% rate of in-house mortality while in women it was 47%; EVAR in men had a 27% rate of in-house mortality while in women it was 32.3%) (p<0.001 in both cases).

 

A commentary on the research by Frank J Veith, also published in JVIR, found that “this article adds but little to the growing body of literature on EVAR and its comparative performance with open repair. However, it is clear that, as time progresses and technical improvements and better skills become widespread, the proportion of abdominal aortic aneurysm patients treated by EVAR or one of its modifications will increase. Nevertheless, there will always be a need for open repair in some patients and in some institutions.”