Nationwide Trends in Abdominal Aortic Aneurysm Repair and Use of Endovascular Repair in the Emergency Setting

Mohan, Pradeep; Rozenfeld, Michael N.; Kane, Richard A.; Calandra, Joseph D.; Hamblin, Michael H.

doi:10.1016/j.jvir.2011.11.015

Cited by 19 publications

(11 citation statements)

References 37 publications

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“…Included in the complications of aortic aneurysm is the risk of rupture, which is defined as bleeding outside the wall of the aneurysm 4 . With a mortality rate as high as 90%, rupture of an aortic aneurysm is a devastating event that requires prompt diagnosis and expedited treatment 5–7 .…”

Section: Introductionmentioning

confidence: 99%

Effects of weekend admission on the outcomes and management of ruptured aortic aneurysms

Groves

Khoshchehreh

et al. 2014

Journal of Vascular Surgery

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Objective Ruptured aortic aneurysm is a condition with a high rate of mortality that requires prompt surgical intervention. It has been noted that in some conditions requiring such prompt intervention, in-hospital mortality is increased in patients admitted on the weekends as compared to patients admitted on weekdays. We sought to determine if this was indeed the case for both ruptured thoracic and abdominal aortic aneurysm and elucidate the possible reasons. Methods Using the Nationwide Inpatient Sample (NIS), a publicly available database of inpatient care, we analyzed the incidence of mortality among 7200 patients admitted on the weekends compared to weekdays for ruptured aortic aneurysm. Among these patients 19% had thoracic aortic aneurysm and 81% had abdominal aortic aneurysm and were analyzed for differences in mortality during the hospitalization. We adjusted for demographics, comorbid conditions, hospital characteristics, rates of surgical intervention, timing of surgical intervention and use of additional therapeutic measures. Results Patients admitted on the weekend for both ruptured thoracic and abdominal aortic aneurysm had a statistically significant increase in mortality as compared to those admitted on the weekdays, Odds ratio (OR) = 2.55, 95% confidence interval (CI) 1.77–3.68, p=0.03 for thoracic and OR =1.32, 95% CI 1.13–1.55, p=0.0004 for abdominal aortic aneurysm. Among those with thoracic aortic aneurysm, a surgical intervention was performed on day of admission in 62.1% of weekday admissions vs. 34.9% weekend admissions, p<.0001. This difference was much smaller among those with an aortic aneurysm, 79.6% had a surgical intervention on day of admission when admitted on a weekday vs. 77.2% on weekend, p<.0001. Conclusions Weekend admission for ruptured aortic aneurysm is associated with an increased mortality when compared to those admitted on the weekend and this is likely due to several factors including a delay in prompt surgical intervention.

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Section: Introductionmentioning

confidence: 99%

Effects of weekend admission on the outcomes and management of ruptured aortic aneurysms

Groves

Khoshchehreh

et al. 2014

Journal of Vascular Surgery

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“…1,2 Since Parodi and colleagues 3 reported their experience using intraluminal graft implants to treat aortic aneurysms, less invasive endovascular aortic aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA) has become applicable in up to 75% of cases requiring intervention. [4][5][6] Such technology is also applicable, albeit to a lesser extent, for thoracic endovascular aortic aneurysm repair (TEVAR). Despite questions about longterm benefit and potentially higher up-front costs, these procedures are more appealing because they have significantly lower 30-day morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Adding an endovascular aortic surgery program to a rural regional medical centre

Marelli¹,

Woo²,

Watson³

et al. 2013

Can J Surg

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E105 RESEARCH • RECHERCHEAdding an endovascular aortic surgery program to a rural regional medical centre Background: Abdominal aortic aneurysms requiring surgical intervention are generally treated by endovascular means. Such procedures are not always offered in rural hospitals, possibly leaving patients underserved. We reviewed our experience initiating an endoaortic surgery program. Methods:A surgeon in a rural centre was credentialed to perform endovascular aortic aneurysm repair through collaboration with a university centre and was proctored locally for the first 5 abdominal aneurysm repairs. Web-based image storage was used to review complex cases as part of an ongoing partnership. Referred patients were screened for multiple aneurysms and underwent long-term monitoring. Results:In all, 160 patients were evaluated for 176 aortic pathologies. Twenty-five patients (17 men) aged 55-89 years underwent 26 endovascular abdominal (n = 23) or thoracic (n = 3) aortic procedures. Emergent endovascular procedures were not performed. There were no operative deaths, requirements for dialysis or conversions to open repair. Two endoleaks required early reintervention. The median length of stay in hospital for endovascular procedures was 2.5 days. Chronic endoleaks were observed in 7 patients. An additional 8 patients underwent open abdominal aneurysm repair locally and 15 patients were referred to the university program. Conclusion:Creation of an endovascular aortic surgery program in a rural hospital is feasible through collaboration with a high-volume centre. Patient safety is enhanced by obtaining second opinions using web-based image review. Most interventions are for abdominal aortic aneurysms, but planning for a comprehensive aortic clinic is preferable.Contexte : Les anévrismes de l'aorte abdominale justiciables d'une intervention chirurgicale sont généralement traités par voie endovasculaire. Ce type d'intervention n'est toutefois pas toujours pratiqué dans les hôpitaux ruraux. Les patients peuvent donc s'en trouver moins bien desservis. Nous avons passé en revu notre expérience après la mise sur pied d'un programme de chirurgie endoaortique.Méthodes : Grâce à une collaboration avec un centre universitaire, un chirurgien d'un centre rural a reçu l'agrément nécessaire pour effectuer la réparation endovasculaire des anévrismes de l'aorte et il a été supervisé localement pour les 5 premières réparations d'anévrisme de l'aorte abdominale. Une banque d'images sur le Web a permis de passer en revue des cas complexes dans le cadre d'un partenariat continu. On a fait subir aux patients adressés en consultation un dépistage d'anévrismes multiples et ils ont fait l'objet d'un suivi à long terme.

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“…2,4 Initially, endovascular treatment was mainly employed for elective cases, however, as the communal experience and comfort level with the new technology increased, an increasing proportion of symptomatic and ruptured aneurysms was being treated with endografts as well. 5,6 Prior studies have looked at the increased uptake of endovascular techniques and the associated cost trends of the technology over the years. 3,6,7 However, to the best of our knowledge, little has been published regarding the resulting national utilization trends of open and endovascular aneurysm repair and its impact on costs.…”

Section: Introductionmentioning

confidence: 99%

“…5,6 Prior studies have looked at the increased uptake of endovascular techniques and the associated cost trends of the technology over the years. 3,6,7 However, to the best of our knowledge, little has been published regarding the resulting national utilization trends of open and endovascular aneurysm repair and its impact on costs. 2 In our current study, we aim to quantify and analyze the clinical and socioeconomic ramifications brought about by these shifts using a large representative national database.…”

Section: Introductionmentioning

confidence: 99%

National temporal trends and determinants of cost of abdominal aortic aneurysm repair

et al. 2020

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Introduction In recent decades, there has been a shift in the management of aortic abdominal aneurysm from open intervention (open aortic aneurysm repair) to an endovascular approach (endovascular aortic aneurysm repair). This shift has yielded clinical as well as socioeconomic reverberations. In our current study, we aim to analyze these effects brought about by the switch to endovascular treatment and to scrutinize the determinants of cost variations between the two treatment modalities. Methods The National (Nationwide) Inpatient Sample database was queried for clinical data ranging from 2001 to 2013 using International Classification of Disease, 9th Revision (ICD-9) codes for open and endovascular aortic repair. Clinical parameters and financial data related to the two treatment modalities were analyzed. Temporal trends of index hospitalization costs were determined. Multivariate linear regression was used to characterize determinants of cost for endovascular aneurysm repair and open abdominal aortic aneurysm repair. Results A total of 128,154 aortic repairs were captured in our analysis, including 62,871 open repairs and 65,283 endovascular repairs. Over the assessed time period, there has been a decrease in the cost of elective endovascular aortic aneurysm repair from $34,975.62 to $31,384.90, a $3,590.72 difference ( p < 0.01), while the cost of open aortic repair has increased from $37,427.77 to $43,640.79 by 2013, a $6,212.79 increase ( p < 0.01). The cost of open aortic aneurysm repair disproportionately increased at urban teaching hospitals, where by 2013, it costs $50,205.59, compared to $34,676.46 at urban nonteaching hospitals, and $34,696.97 at rural institutions. Urban teaching hospitals were found to perform an increasing proportion of complex open aneurysm repairs, involving concomitant renal and visceral bypass procedures. On multivariate analysis, strong determinants of cost increase for both endovascular aortic aneurysm repair and open aortic aneurysm repair are rupture status, prolonged length of stay, occurrence of complications, and the need for disposition to a nursing facility or another acute care institution. Conclusion As the vascular community has shifted from an open repair of abdominal aortic aneurysm to an endovascular approach, a number of unforeseen clinical and economic effects were noted. We have characterized these ramifications to help guide further clinical decision and resource allocation.

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Nationwide Trends in Abdominal Aortic Aneurysm Repair and Use of Endovascular Repair in the Emergency Setting

Cited by 19 publications

References 37 publications

Effects of weekend admission on the outcomes and management of ruptured aortic aneurysms

Effects of weekend admission on the outcomes and management of ruptured aortic aneurysms

Adding an endovascular aortic surgery program to a rural regional medical centre

National temporal trends and determinants of cost of abdominal aortic aneurysm repair

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