Comparative effectiveness of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Medicare population

Samuel Edwards, Marc L. Schermerhorn, A. James O'Malley, Rodney P. Bensley, Rob Hurks, Philip Cotterill, Bruce E. Landon

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Objective Endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) is increasingly used for emergent treatment of ruptured AAA (rAAA). We sought to compare the perioperative and long-term mortality, procedure-related complications, and rates of reintervention of EVAR vs open aortic repair of rAAA in Medicare beneficiaries. Methods We examined perioperative and long-term mortality and complications after EVAR or open aortic repair performed for rAAA in all traditional Medicare beneficiaries discharged from a United States hospital from 2001 to 2008. Patients were matched by propensity score on baseline demographics, coexisting conditions, admission source, and hospital volume of rAAA repair. Sensitivity analyses were performed to evaluate the effect of bias that might have resulted from unmeasured confounders. Results Of 10,998 patients with repaired rAAA, 1126 underwent EVAR and 9872 underwent open repair. Propensity score matching yielded 1099 patient pairs. The average age was 78 years, and 72.4% were male. Perioperative mortality was 33.8% for EVAR and 47.7% for open repair (P <.001), and this difference persisted for >4 years. At 36 months, EVAR patients had higher rates of AAA-related reinterventions than open repair patients (endovascular reintervention, 10.9% vs 1.5%; P <.001), whereas open patients had more laparotomy-related complications (incisional hernia repair, 1.8% vs 6.2%; P <.001; all surgical complications, 4.4% vs 9.1%; P <.001). Use of EVAR for rAAA increased from 6% of cases in 2001 to 31% in 2008, whereas during the same interval, overall 30-day mortality for admission for rAAA, regardless of treatment, decreased from 55.8% to 50.9%. Conclusions EVAR for rAAA is associated with lower perioperative and long-term mortality in Medicare beneficiaries. Increasing adoption of EVAR for rAAA is associated with an overall decrease in mortality of patients hospitalized for rAAA during the last decade.

Original languageEnglish (US)
JournalJournal of vascular surgery
Volume59
Issue number3
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Aortic Rupture
Abdominal Aortic Aneurysm
Medicare
Mortality
Population
Propensity Score
State Hospitals
Herniorrhaphy
Laparotomy
Demography
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Comparative effectiveness of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Medicare population. / Edwards, Samuel; Schermerhorn, Marc L.; O'Malley, A. James; Bensley, Rodney P.; Hurks, Rob; Cotterill, Philip; Landon, Bruce E.

In: Journal of vascular surgery, Vol. 59, No. 3, 01.01.2014.

Research output: Contribution to journalArticle

Edwards, Samuel ; Schermerhorn, Marc L. ; O'Malley, A. James ; Bensley, Rodney P. ; Hurks, Rob ; Cotterill, Philip ; Landon, Bruce E. / Comparative effectiveness of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Medicare population. In: Journal of vascular surgery. 2014 ; Vol. 59, No. 3.
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title = "Comparative effectiveness of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Medicare population",
abstract = "Objective Endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) is increasingly used for emergent treatment of ruptured AAA (rAAA). We sought to compare the perioperative and long-term mortality, procedure-related complications, and rates of reintervention of EVAR vs open aortic repair of rAAA in Medicare beneficiaries. Methods We examined perioperative and long-term mortality and complications after EVAR or open aortic repair performed for rAAA in all traditional Medicare beneficiaries discharged from a United States hospital from 2001 to 2008. Patients were matched by propensity score on baseline demographics, coexisting conditions, admission source, and hospital volume of rAAA repair. Sensitivity analyses were performed to evaluate the effect of bias that might have resulted from unmeasured confounders. Results Of 10,998 patients with repaired rAAA, 1126 underwent EVAR and 9872 underwent open repair. Propensity score matching yielded 1099 patient pairs. The average age was 78 years, and 72.4{\%} were male. Perioperative mortality was 33.8{\%} for EVAR and 47.7{\%} for open repair (P <.001), and this difference persisted for >4 years. At 36 months, EVAR patients had higher rates of AAA-related reinterventions than open repair patients (endovascular reintervention, 10.9{\%} vs 1.5{\%}; P <.001), whereas open patients had more laparotomy-related complications (incisional hernia repair, 1.8{\%} vs 6.2{\%}; P <.001; all surgical complications, 4.4{\%} vs 9.1{\%}; P <.001). Use of EVAR for rAAA increased from 6{\%} of cases in 2001 to 31{\%} in 2008, whereas during the same interval, overall 30-day mortality for admission for rAAA, regardless of treatment, decreased from 55.8{\%} to 50.9{\%}. Conclusions EVAR for rAAA is associated with lower perioperative and long-term mortality in Medicare beneficiaries. Increasing adoption of EVAR for rAAA is associated with an overall decrease in mortality of patients hospitalized for rAAA during the last decade.",
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AU - Edwards, Samuel

AU - Schermerhorn, Marc L.

AU - O'Malley, A. James

AU - Bensley, Rodney P.

AU - Hurks, Rob

AU - Cotterill, Philip

AU - Landon, Bruce E.

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N2 - Objective Endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) is increasingly used for emergent treatment of ruptured AAA (rAAA). We sought to compare the perioperative and long-term mortality, procedure-related complications, and rates of reintervention of EVAR vs open aortic repair of rAAA in Medicare beneficiaries. Methods We examined perioperative and long-term mortality and complications after EVAR or open aortic repair performed for rAAA in all traditional Medicare beneficiaries discharged from a United States hospital from 2001 to 2008. Patients were matched by propensity score on baseline demographics, coexisting conditions, admission source, and hospital volume of rAAA repair. Sensitivity analyses were performed to evaluate the effect of bias that might have resulted from unmeasured confounders. Results Of 10,998 patients with repaired rAAA, 1126 underwent EVAR and 9872 underwent open repair. Propensity score matching yielded 1099 patient pairs. The average age was 78 years, and 72.4% were male. Perioperative mortality was 33.8% for EVAR and 47.7% for open repair (P <.001), and this difference persisted for >4 years. At 36 months, EVAR patients had higher rates of AAA-related reinterventions than open repair patients (endovascular reintervention, 10.9% vs 1.5%; P <.001), whereas open patients had more laparotomy-related complications (incisional hernia repair, 1.8% vs 6.2%; P <.001; all surgical complications, 4.4% vs 9.1%; P <.001). Use of EVAR for rAAA increased from 6% of cases in 2001 to 31% in 2008, whereas during the same interval, overall 30-day mortality for admission for rAAA, regardless of treatment, decreased from 55.8% to 50.9%. Conclusions EVAR for rAAA is associated with lower perioperative and long-term mortality in Medicare beneficiaries. Increasing adoption of EVAR for rAAA is associated with an overall decrease in mortality of patients hospitalized for rAAA during the last decade.

AB - Objective Endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) is increasingly used for emergent treatment of ruptured AAA (rAAA). We sought to compare the perioperative and long-term mortality, procedure-related complications, and rates of reintervention of EVAR vs open aortic repair of rAAA in Medicare beneficiaries. Methods We examined perioperative and long-term mortality and complications after EVAR or open aortic repair performed for rAAA in all traditional Medicare beneficiaries discharged from a United States hospital from 2001 to 2008. Patients were matched by propensity score on baseline demographics, coexisting conditions, admission source, and hospital volume of rAAA repair. Sensitivity analyses were performed to evaluate the effect of bias that might have resulted from unmeasured confounders. Results Of 10,998 patients with repaired rAAA, 1126 underwent EVAR and 9872 underwent open repair. Propensity score matching yielded 1099 patient pairs. The average age was 78 years, and 72.4% were male. Perioperative mortality was 33.8% for EVAR and 47.7% for open repair (P <.001), and this difference persisted for >4 years. At 36 months, EVAR patients had higher rates of AAA-related reinterventions than open repair patients (endovascular reintervention, 10.9% vs 1.5%; P <.001), whereas open patients had more laparotomy-related complications (incisional hernia repair, 1.8% vs 6.2%; P <.001; all surgical complications, 4.4% vs 9.1%; P <.001). Use of EVAR for rAAA increased from 6% of cases in 2001 to 31% in 2008, whereas during the same interval, overall 30-day mortality for admission for rAAA, regardless of treatment, decreased from 55.8% to 50.9%. Conclusions EVAR for rAAA is associated with lower perioperative and long-term mortality in Medicare beneficiaries. Increasing adoption of EVAR for rAAA is associated with an overall decrease in mortality of patients hospitalized for rAAA during the last decade.

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