Open Versus Endovascular Abdominal Aortic Aneurysm Repair in VA Hospitals

Received 2 January 2006; accepted 11 January 2006.

Background

Endovascular abdominal aortic aneurysm repair (EVAR), when compared with conventional open surgical repair, has been shown to reduce perioperative morbidity and mortality. We performed a retrospective cohort study with prospectively collected data from the Department of Veterans Affairs to examine outcomes after elective aneurysm repair.

Study design

We studied 30-day mortality, 1-year survival, and postoperative complications in 1,904 patients who underwent elective abdominal aortic aneurysm repair (EVAR n=717 [37.7%]; open n=1,187 [62.3%]) at 123 Department of Veterans Affairs hospitals between May 1, 2001 and September 30, 2003. We investigated the influence of patient, operative, and hospital variables on outcomes.

Results

Patients undergoing EVAR had significantly lower 30-day (3.1% versus 5.6%, p=0.01) and 1- year mortality rates (8.7% versus 12.1%, p=0.018) than patients having open repair. EVAR was associated with a decrease in 30-day postoperative mortality (adjusted odds ratio[OR]=0.59; 95% CI=0.36, 0.99; p=0.04). The risk of perioperative complications was much less after EVAR (15.5% versus 27.7%; p < 0.001; unadjusted OR 0.48; 95% CI=0.38, 0.61; p < 0.001). Patients operated on at low volume hospitals (25% of entire cohort) were more likely to have had open repair (31.3% compared with 15.9% EVAR; p < 0.001) and a nearly two-fold increase in adjusted 30-day mortality risk (OR=1.9; 95% CI=1.19, 2.98; p=0.006).

Conclusions

In routine daily practice, veterans who undergo elective EVAR have substantially lower perioperative mortality and morbidity rates compared with patients having open repair. The benefits of a minimally invasive approach were readily apparent in this cohort, but we recommend using caution in choosing EVAR for all elective abdominal aortic aneurysm repairs until longer-term data on device durability are available.

Abbreviations and Acronyms: AAA, abdominal aortic aneurysm , ASA, American Society of Anesthesiologists , BIRLS, Beneficiary Identification Record Locator System , CPT, current procedural terminology , EVAR, endovascular abdominal aortic aneurysm repair , NSQIP, National Surgical Quality Improvement Program , OR, odds ratio , VA, Department of Veterans Affairs

a Houston Center for Quality of Care and Utilization Studies, Michael E DeBakey Veterans Affairs Medical Center

b Department of Medicine

c Michael E DeBakey Department of Surgery Baylor College of Medicine, Houston, TX

d University of Colorado Health Outcomes Program, Denver, CO

e Harvard Medical School, VA Boston Healthcare System, Boston, MA

Correspondence address: Ruth L Bush, MD, Michael E DeBakey Department of Surgery, Baylor College of Medicine, 1709 Dryden, Suite 1568, Houston, TX 77030.

Competing Interests Declared: None.

Local funding from the Houston Center for Quality of Care and Utilization Studies, Houston, TX supported this work.

PII: S1072-7515(06)00043-3

doi:10.1016/j.jamcollsurg.2006.01.005

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