National Trends of Mortality and Resource Utilization for Endovascular and Open Abdominal Aortic Repair

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Hossein Bagshahi, MD, Brian D. Park, MD, Louis M. Messina, MD, Mohammad Eslami, MD.
UMASS Medical School, Worcester, MA, USA.

Objectives:
Repair of abdominal aortic aneurysm (AAA) has undergone a paradigm shift over the last decade with the advances in the endovascular aneurysm repair (EVAR) technology. The objective of this study is to analyze the current national trends of surgical treatment of AAA using open (OAR) and EVAR techniques in terms of mortality and resource utilization.
Methods:
The Nationwide Inpatient Sample (NIS) from 2001 to 2005 was queried to identify patients undergoing OAR and EVAR. In-hospital mortality as well as hospital length of stay (LOS), and average charges (as a measure of resource utilization) were investigated.
Results:
From 2001 to 2005 there were a total of 198364 AAA repairs: 111,873 OAR vs. 86,491 EVAR There has been a decrease in the number of OARs (30, 140 in 2001 to 16,607 in 2005, p<0.05), and a corresponding increase in EVARs (13,839 in 2001 to 21,552 in 2005, p<0.05). LOS for OAR was consistently greater than that for EVAR (9.6 vs. 3.8 in 2001, and 10.6 vs. 3.8 in 2005, p<0.0001). Mortality for OAR was also greater than EVAR (10.38% vs. 2.42% in 2001, 12.33% vs. 2.14%, p<0.0001). Average charges were also significantly higher for open vs. EVAR repair ($62,662 vs. $56,389 in 2002, $87,367 vs. $68,593 in 2005, p<0.05).
Conclusion:
From 2001 to 2005 a significant shift toward the utilization of EVAR was noted. In hospital mortality rates, LOS and charges were significantly less for EVAR admissions. These advantages justify the trend toward greater utilization of the minimally invasive approach.

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