A. Cha1, V. Dombrovskiy1, N. Nassiri1, R. Shafritz1, S. Rahimi1 1Robert Wood Johnson – UMDNJ,Vascular Surgery,New Brunswick, NJ, USA
Introduction: There has been debate in the literature as to whether endovascular repair of ruptured abdominal aortic aneurysms has a survival advantage over open surgery. The purpose of this study was to evaluate a large subset of Medicare patients with ruptured abdominal aortic aneurysms who underwent endovascular repair or open surgery, and evaluate postoperative complications, survival and 30-day readmission rates.
Methods: Study population was selected from 2005-2009 MedPAR data with the appropriate ICD-9-CM diagnosis and procedure codes. Statistics was performed with the Chi-square test, multivariable logistic regression analysis, Kaplan-Meier survival curves and Cox proportional hazards modelling
Results: 8,480 patients (1,939 with endovascular repair and 6,541 with open surgery) were identified. Patients with open surgery were younger than those with endovascular repair and had less comorbidities. However, patients with open surgery had more postoperative complications (OR[odds ratio]=2.1; 95%CI [confidence interval] 1.9-2.4), including cardiac (OR=1.4; 95%CI 1.2-1.6), respiratory (OR=2.2; 95%CI 1.9-2.4) and renal complications (OR=1.5; 95%CI 1.4-1.7). They had more infectious complications (OR=1.3; 95%CI 1.2-1.5) such as pneumonia (OR=1.6; 95%CI 1.3-1.8), sepsis and bloodstream infection (OR=1.4; 95%CI 1.2-1.7), clostridium difficile (OR=2.2; 95%CI 1.3-3.7). As a result, patients with open surgery had greater rates of hospital mortality (43% vs 28.4%; P<0.0001) and worse survival during 1 year after surgery (HR[hazard ratio]=1.4; 95%CI 1.3-1.5). At the same time, patients after endovascular repair compared to those with open surgery had greater 30-day readmission rates (22.5% vs 19.5%; P=0.02). However, readmissions for the repeated repair were rare in both groups: 0.14% after open surgery and 0.65% after endovascular repair.
Conclusion: Although there is a higher 30-day readmission rate to the hospital after endovascular repair compared to open surgery, patients after endovascular repair had significantly lower rates of postoperative complications and better survival. Endovascular repair of ruptured AAA should be first line therapy when technically feasible.