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Has the implementation of EVAR for ruptured AAA improved outcomes?
Todd R Vogel1, Viktor Y Dombrovskiy, Paul B Haser
1Division of Vascular Surgery, Robert Wood Johnson Medical School, and The Surgical Outcomes Research Group, New Brunswick, New Jersey, USA. vogelto@umdnj.edu
Vascular and Endovascular Surgery
|January 10, 2009
Summary
Endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysms (rAAA) did not improve survival in this state, despite higher costs. Further regional analysis is needed as EVAR use increases for rAAA treatment.
Area of Science:
- Vascular Surgery
- Health Services Research
Background:
- Previous studies suggest endovascular aneurysm repair (EVAR) improves outcomes for ruptured abdominal aortic aneurysms (rAAA).
- Regional variations in healthcare access and practice may influence EVAR effectiveness for rAAA.
Purpose of the Study:
- To evaluate the outcomes, costs, and hospital length of stay (LOS) associated with EVAR compared to open surgery (OS) for rAAA within a specific state.
- To identify predictors of mortality in patients undergoing rAAA repair.
Main Methods:
- Retrospective cohort study utilizing state inpatient data from 2001-2005.
- Analysis of 700 patients who underwent repair for rAAA, comparing EVAR (n=82) and OS (n=618).
Main Results:
- Mortality rates for rAAA repair were similar between EVAR and OS (45.1% vs. 52.4%).
- EVAR was significantly more expensive ($51,339 vs. $39,967) with similar hospital LOS (14.08 vs. 13.42 days).
- Lack of insurance was a significant predictor of mortality (OR = 5.1).
Conclusions:
- EVAR did not demonstrate a survival benefit for rAAA in this state and incurred higher costs.
- Similar hospital LOS was observed for both EVAR and OS in rAAA repair.
- Further investigation into regional factors influencing EVAR outcomes for rAAA is warranted.
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