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 PS14. EVAR in the Elderly: Trends and Outcomes from the Nationwide Inpatient Sample

​Brian D. Park1, Nchang M. Azefor1, Chun-Chih Huang1, Cameron Akbari1, Frederick P. Beavers1, David Deaton2, Robyn S. Macsata3, Sean O'Donnell1, Susanna Shin1, John J. Ricotta1
1The Washington Hospital Center, Washington, DC; 2Georgetown University Hospital, Washington, DC; 3Veterans Affairs Medical Center, Washington, DC.

OBJECTIVES: To identify trends in EVAR utilization and outcomes over a 5-year period in a nationwide data set.

METHODS: The Nationwide Inpatient Sample database was queried for the years 2005 to 2009. Number of EVAR cases, ratio of EVAR/Open repair (OR), major clinical outcomes, hospital costs and discharge status were analyzed by decade. Interval data were compared with ANOVA and proportions via chi squared tests.

RESULTS: There were 174,714 AAA repairs (124,869 EVAR) identified. The ratio of EVAR/OR increased with increasing age. Between the years of 2005 and 2009, the number of AAA repairs in the elderly increased by 21% (7,179 vs. 8,554) and EVAR in patients ≥80 increased by 50% (5,057 vs.7,650 p<.05).In 2009 85% of AAA repairs in patients over 80 were EVAR. 25% of all EVAR cases were performed in age >80 patients.
In hospital mortality rate, remained acceptable in all age groups. EVAR associated mortality, length of stay, hospital costs, and discharge to skilled nursing facilities associated increased with each successive decade of life (p<.05). Postoperative MI and acute renal failure also increased with increasing age (p<.05). Results of EVAR by decade are presented below.

CONCLUSIONS: One quarter of all EVAR cases are being performed in patients  ≥80 with overall low mortality rates. There is an age dependent increase in death, complications, hospital costs and discharge to extended care facilities. Such factors, and long term aneurysm related death, should be considered when evaluating the appropriateness of elective aneurysm repair in the elderly.

AUTHOR DISCLOSURES: C. Akbari, Nothing to disclose; N. M. Azefor, Nothing to disclose; F. P. Beavers, Nothing to disclose; D. Deaton, Nothing to disclose; C. Huang, Nothing to disclose; R. S. Macsata, Nothing to disclose; S. O'Donnell, Nothing to disclose; B. D. Park, Nothing to disclose; J. J. Ricotta, Nothing to disclose; S. Shin, Nothing to disclose.

Age Group
60-69 Years
70-79 Years
80-89 Years
90+ Years
Number of Patients
33,629
56,783
32,493
1,964
In Hospital Mortality
.46%
.70%
1.56%
2.49%
Average Length of Stay
2.7
3.1
3.6
4.6
Myocardial Infarction
3.69%
4.19%
4.81%
8.41%
Acute Renal Failure
1.21%
1.92%
2.87%
4.0%
Average Hospital Cost
$26,399
$27,350
$28,490
$30,741
Discharge to SNF
2.19%
5.21%
11.12%
22.29%

Posted April 2012

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