Open versus endovascular abdominal aortic aneurysm repair in VA hospitals

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 I 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.