USA: EVAR performed in an emergency setting showed steady rise

255

From 2001 to 2006, there was a steady and significant increase in the number of EVAR procedures performed for emergency admissions, Prasoon Mohan told delegates at the Society of Interventional Radiology’s 36th Annual Meeting in Chicago, USA.

The study set out to identify the nationwide trends in utilisation of endovascular abdominal aortic aneurysm repair (EVAR) in emergency setting and to compare the trends in cost and outcomes with that of open abdominal aortic aneurysm repair. It also aimed to assess whether the increase in emergency procedures had an impact on the outcomes of EVAR.

 

Mohan, St Francis Hospital, Evanston, USA, said, “Despite the increase in emergency procedures, in-hospital mortality rate and mean hospital stay associated with EVAR showed a steady and significant fall from 2001 to 2008. There was a significant increase in the number of patients needing institutional rehabilitation and home health care following EVAR during the study period.”

 

The investigators searched for principal procedures of EVAR and open repair from 2000 to 2008 using the ICD-9-CM codes from the National Inpatient Sample from the Healthcare Cost and Utilization Project. “All analyses were performed on data that were weighted to provide national estimates. The Z-test was used for significance testing,” noted Mohan.

 

Results

 

  • Mohan told delegates that the total number of EVAR procedures showed a steady increase from 2,338 in 2000 to 3,5281in 2008 (p<0.01).
  • EVAR procedures performed for emergency admissions showed a steady increase from 464 in 2001 to 2,073 in 2006 (p<0.01).
  • However, emergency open repair fell from 5,780 to 3,228 during the same period (p<0.001).
  • The total hospital cost for open repair was consistently higher than EVAR, and the difference in cost showed a steep increase from US$3,948 in 2001 to US$34,461 in 2008.
  • Mean hospital cost of EVAR increased 68% from 2000 to 2008. The cost of open repair increased 147%, and the rise in average US hospital costs was about 110%.
  • Significant increase in the total number of EVARs and emergency EVARs from 2001–2006. Length of hospital stay and in-hospital mortality showed a decreasing trend from 2000–2008.

 

“Despite the increase in the emergency EVAR procedures since 2001, in-hospital mortality rates associated with EVAR showed a steady decline from 2.42% in 2001 to 1.86% in 2008 (p=0.16). The mean length of hospital stay for EVAR fell from 4.3 in 2000 to 3.6 days in 2008 (p=0.02), while the mean hospital stay for open repair increased from 9.3 to 11 days (p<0.01). The number of patients needing institutional rehabilitation following open repair decreased from 4,698 in 2000 to 2,776 in 2008 (p<0.001) while that for EVAR showed a steady increase from 1,26 to 2,463 (p<0.001),” said Mohan.

 

He pointed out that the limitations of the study included that the National Inpatient Sample is an administrative database which might have coding errors and missed entries. Patients who died in hospital might have had co-morbidities and that the data was limited to in-hospital mortality.