Short- and long-term survival after open versus endovascular repair of abdominal aortic aneurysm—Polish population analysis

Abstract

ObjectivesThe aim of the study was to compare short and long-term mortality and readmissions in patients with non-ruptured abdominal aortic aneurysm (AAA) treated with endovascular aortic repair (EVAR) or open aneurysm repair (OAR).DesignRetrospective survival analysis based on prospectively collected medical records of the national Polish public health insurer.MaterialsIn the National Health Fund database we identified all patients who underwent elective open or endovascular treatment of AAA between January 1st 2011 and March 22nd 2016. The data on mortality, selected concomitant diseases and readmissions were collected. A total of 7805 patients (mean age 70.9±8.1 yrs, 85.8% males) underwent OAR (n = 2336) or EVAR (n = 5469). A median follow up was 27.5 months (IQR range 10.0–38.4 months).MethodsThe primary outcome variable was all-cause mortality, secondary outcomes included 30-day mortality and readmissions. Kaplan–Meier (K-M), Cox proportional-hazards and propensity score analyses were performed for primary and secondary outcomes adjusting for repair type of AAA (OAR vs. EVAR), age, sex and concomitant diseases.ResultsEVAR patients had higher all-cause mortality (6.4% vs. 4.6% P = 0.002, adjHR 1.34, 95%CI 1.07–1.67, P = 0.010) compared with OAR. The mortality risks for OAR patients decreased below those for EVAR patients after 9.9 months. Of all the tested confounding factors only age independently and significantly influenced long-term mortality. Readmissions occurred more often in EVAR than in OAR (16.5% vs. 8.4% P<0.001, adjHR 2.15, 95%CI 1.84–2.52, P<0.001) independently from other covariants. Survival and readmissions Kaplan-Meier curves remained statistically different between OAR and EVAR patients after propensity score matching.ConclusionsSurvival benefit of EVAR over OAR disappeared early during the first year after procedure, particularly in patients below 70 years of age, accompanied by an increased frequency of readmissions of EVAR patients. Our data suggest re-evaluation of the strategy for AAA management in vascular units in the country.

Readmission and Utilization After Repair of Ruptured Abdominal Aortic Aneurysms in the United States

“…17,18 Authors have suggested that there is no difference in the readmission rates when comparing elective EVAR and elective open AAA repair, 17,25 others suggest that readmissions occur more frequently in patients treated with EVAR when compared to those treated open repair. 26 This analysis found increased readmission after non-elective EVAR compared to open ruptured aneurysm repair.…”

Readmission and Utilization After Repair of Ruptured Abdominal Aortic Aneurysms in the United States

“…17,18 Authors have suggested that there is no difference in the readmission rates when comparing elective EVAR and elective open AAA repair, 17,25 others suggest that readmissions occur more frequently in patients treated with EVAR when compared to those treated open repair. 26 This analysis found increased readmission after non-elective EVAR compared to open ruptured aneurysm repair.…”

Impact of Gradual Adoption of EVAR in Elective Repair of Abdominal Aortic Aneurysm: A Retrospective Cohort Study from 2009 to 2015

“…Similar findings were reported in recent observational studies, including propensity-weighted analysis. 7,21,27 Nevertheless, significantly higher 19,22 and lower 28 reintervention rates in the EVAR group were also described. A meta-analysis of the four multicenter randomized trials of EVAR versus OSR reported higher overall rates of reintervention related to AAA in the EVAR group, mainly due to type II and type I endoleaks.…”

Outcomes of Type II Endoleak Treatment Using Ethylene Vinyl Alcohol Copolymer (Onyx TM )

“…35 Abdominal aortic aneurysm is a disease of the elderly with median age at EVAR ranging from approximately 73-75 years. [36][37][38][39] The 5-year survival after EVAR ranges from 57%-75%. [40][41][42][43][44] Previous studies have shown that the majority of deaths after EVAR are due to non-surgical causes such as cardiovascular disease and cancer.…”

Readmission and Utilization After Repair of Ruptured Abdominal Aortic Aneurysms in the United States

“…17,18 Authors have suggested that there is no difference in the readmission rates when comparing elective EVAR and elective open AAA repair, 17,25 others suggest that readmissions occur more frequently in patients treated with EVAR when compared to those treated open repair. 26 This analysis found increased readmission after non-elective EVAR compared to open ruptured aneurysm repair.…”

Impact of Gradual Adoption of EVAR in Elective Repair of Abdominal Aortic Aneurysm: A Retrospective Cohort Study from 2009 to 2015

“…Similar findings were reported in recent observational studies, including propensity-weighted analysis. 7,21,27 Nevertheless, significantly higher 19,22 and lower 28 reintervention rates in the EVAR group were also described. A meta-analysis of the four multicenter randomized trials of EVAR versus OSR reported higher overall rates of reintervention related to AAA in the EVAR group, mainly due to type II and type I endoleaks.…”

Outcomes of Type II Endoleak Treatment Using Ethylene Vinyl Alcohol Copolymer (Onyx TM )

“…35 Abdominal aortic aneurysm is a disease of the elderly with median age at EVAR ranging from approximately 73-75 years. [36][37][38][39] The 5-year survival after EVAR ranges from 57%-75%. [40][41][42][43][44] Previous studies have shown that the majority of deaths after EVAR are due to non-surgical causes such as cardiovascular disease and cancer.…”

Readmission and Utilization After Repair of Ruptured Abdominal Aortic Aneurysms in the United States

“…17,18 Authors have suggested that there is no difference in the readmission rates when comparing elective EVAR and elective open AAA repair, 17,25 others suggest that readmissions occur more frequently in patients treated with EVAR when compared to those treated open repair. 26 This analysis found increased readmission after non-elective EVAR compared to open ruptured aneurysm repair.…”

Impact of Gradual Adoption of EVAR in Elective Repair of Abdominal Aortic Aneurysm: A Retrospective Cohort Study from 2009 to 2015

“…Similar findings were reported in recent observational studies, including propensity-weighted analysis. 7,21,27 Nevertheless, significantly higher 19,22 and lower 28 reintervention rates in the EVAR group were also described. A meta-analysis of the four multicenter randomized trials of EVAR versus OSR reported higher overall rates of reintervention related to AAA in the EVAR group, mainly due to type II and type I endoleaks.…”

Outcomes of Type II Endoleak Treatment Using Ethylene Vinyl Alcohol Copolymer (Onyx TM )

“…35 Abdominal aortic aneurysm is a disease of the elderly with median age at EVAR ranging from approximately 73-75 years. [36][37][38][39] The 5-year survival after EVAR ranges from 57%-75%. [40][41][42][43][44] Previous studies have shown that the majority of deaths after EVAR are due to non-surgical causes such as cardiovascular disease and cancer.…”