title: Challenges associated with the integration of endovascular repair of abdominal aortic aneurysms in a community hospital.
abstract: OBJECTIVE
  There has been considerable debate regarding the proper place for endovascular repair (ER) of abdominal aortic aneurysms (AAAs) versus traditional open repair (OR). Our study compared preoperative patient demographics and outcomes for elective, asymptomatic AAA repairs performed at our center over a 33-month period.
  
  
  METHODS
  For this study, we selected 342 consecutive elective infrarenal AAA repairs performed between July 1, 2000, and March 31, 2003, at Riverside Methodist Hospital. The patients underwent either ER or OR, depending on patient and surgeon collaborative determinations. Ruptured and symptomatic AAAs were excluded from our study. Preoperative demographics, anesthesia, complications, and discharge status for the 2 groups were analyzed, and statistical analysis was done to determine statistically significant differences.
  
  
  RESULTS
  The preoperative status of the ER and OR patient groups were essentially similar. There were only 3 significant differences between the 2 groups: alcohol use was higher for the OR group than for the ER group (12.0% versus 5.2%; P = .04), and the incidence of type II diabetes mellitus and peripheral vascular disease were lower for the OR group compared with the ER group (6.7% versus 13.4% [P = .04] and 18.3% versus 30.6% [P = .008], respectively). The OR group used more general anesthesia than the ER group (99% versus 86%; P < .001) and had more complications, including dysrhythmia (8.65% versus 1.59%; P = .005), ileus (13.94% versus 0.79%; P < .0001), infection (8.17% versus 0.0%; P = .0007), respiratory complications (12.50% versus 1.59%; P = .0003), and renal complications (5.29% versus 0.79%; P = .032). The ER group had a higher rate of wound hematoma (4.76% versus 0.48%; P = .007). ER patients also had significantly less blood loss (379 mL versus 1930 mL; P < .001), a better independent discharge status (P < .0001), a shorter length of stay (1.8 days versus 8.2 days; P < .001), and a lower mortality rate (0.75% versus 3.85%; P = .0954).
  
  
  CONCLUSIONS
  From our study we cautiously continue to encourage the consideration of the ER of AAAs in our patient population while being mindful of its limitations.
authors.affiliation: Division of Endovascular Medicine and Surgery, Riverside Methodist Hospital, Columbus, Ohio, USA.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Watson
authors.forename: James
authors.initials: J
authors.lastname: Tan
authors.forename: Lori
authors.initials: L
authors.lastname: Wiseman
authors.forename: Gary M
authors.initials: GM
authors.lastname: Ansel
authors.forename: Chip
authors.initials: C
authors.lastname: Botti
authors.forename: Barry
authors.initials: B
authors.lastname: George
authors.forename: Richard
authors.initials: R
authors.lastname: Snow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology* / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data*; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data*; D005260:Female; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data*