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Home > Vascular Annual Meeting > giles_population_based

Population Based Outcomes Following Endovascular and Open Repair of Ruptured Abdominal Aortic Aneurysms

Kristina Giles, Allen Hamdan, Frank Pomposelli, Ami Jhaveri, Suzanne Dahlberg, Marc Schermerhorn.
Beth Israel Deaconess Medical Center, Boston, Mass.

OBJECTIVES: To evaluate national outcomes after endovascular and open surgical repair of ruptured abdominal aortic aneurysms (RAAA).

METHODS: Repairs of ruptured aneurysms were identified within the 2000-2005 Nationwide Inpatient Sample database using ICD-9 diagnosis codes for RAAA and selecting for endovascular or open repair. Primary and secondary outcomes included in-hospital mortality, length of stay (LOS), complication rate, and hospitalization charge. A secondary analysis was performed to compare outcomes from low, medium, and high volume institutions as defined by the number of RAAA repairs performed yearly.

RESULTS: There were a total of 449 endovascular repairs and 5,328 open repairs of RAAAs identified from 2000-2005. Median age overall was 73 years with a trend for endovascular patients to be older (75 vs. 73 years, p=0.069). In-hospital mortality was 41% overall; 33% and 41% for endovascular vs. open repairs respectively (p=0.003). Mortality differences were significant for the age groups 65-74 years and ≥75 years, however the age group <65 years showed no significant mortality difference between repair type. Length of stay was shorter after endovascular repair (7 days vs. 9 days, p<.0001). Respiratory complications (8% vs. 4%, p=.01) and acute renal failure were more common following open repair (30% vs. 25%, p=.02). Hospitalization cost was similar (Endo $73,589, Open $67,249 , p=0.25). Mortality decreased as hospital surgical volume increased (LVH 46%, MVH 43%, HVH 39%, p=.0004) while LOS and hospitalization charge both increased. Overall multivariate predictors of mortality were age, female gender, lower hospital surgical volume, and open vs. endovascular repair [Table 1].

CONCLUSIONS: This population based study shows mortality associated with RAAAs is improved by the performance of endovascular repair especially in older patients. Average costs were similar between the two types of repairs. This study also demonstrates decreased mortality after ruptured aneurysm repair at high volume institutions.

AUTHOR DISCLOSURES: K. Giles, None; A. Hamdan, None; F. Pomposelli, None; A. Jhaveri, None; S. Dahlberg, None; M. Schermerhorn, None.