title: Endovascular aortic aneurysm repair in patients with the highest risk and in-hospital mortality in the United States.
abstract: BACKGROUND
  A randomized clinical trial from the United Kingdom (EVAR trial 2) comparing endovascular aortic aneurysm repair (EVAR) with no intervention found no advantage for EVAR in patients with high risk. This finding was predominantly caused by the substantial in-hospital mortality after EVAR (9%).
  
  
  OBJECTIVE
  The nationwide in-hospital mortality for patients with the highest risk undergoing EVAR in the United States is lower than that reported in EVAR trial 2.
  
  
  METHODS
  Population-based, cross-sectional study.
  
  
  METHODS
  The 2001-2004 Nationwide Inpatient Sample.
  
  
  METHODS
  The Nationwide Inpatient Sample identified EVAR procedures for nonruptured abdominal aortic aneurysms. Risk stratification was based on comorbidities and the Charlson comorbidity index, a validated predictor of in-hospital mortality after abdominal aortic aneurysms repairs. Weighted univariate and logistic regression analyses were used to determine the association between comorbidity measures and risk-adjusted in-hospital mortality.
  
  
  RESULTS
  During the 4-year period, 65 502 EVARs were performed with an in-hospital mortality of 2.2%. Risk-adjusted in-hospital mortality rates ranged from 1.2% to 3.7%. Stratified analyses, including only elective EVAR procedures, revealed that in-hospital mortality was significantly higher in patients with the most severe comorbidities (1.7%) vs those with lower comorbidity (0.4%; P<.001). Patients with high risk had only a 1.6-fold increased risk of adjusted in-hospital mortality (odds ratio, 1.6; 95% confidence interval, 1.2-2.2) compared with patients with low risk.
  
  
  CONCLUSIONS
  The EVAR procedure is currently being performed in the United States with low in-hospital mortality, even in patients with the highest risk. Therefore, EVAR should not be denied to high-risk patients with abdominal aortic aneurysms in the United States on the basis of the level I evidence from the United Kingdom study.
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, 5909 Harry Hines Boulevard, Dallas, TX 75390-9157, USA. carlos.timaran@utsouthwestern.edu
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Timaran
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Veith
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rosero
authors.forename: J Gregory
authors.initials: JG
authors.lastname: Modrall
authors.forename: Frank R
authors.initials: FR
authors.lastname: Arko
authors.forename: G Patrick
authors.initials: GP
authors.lastname: Clagett
authors.forename: R James
authors.initials: RJ
authors.lastname: Valentine
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000401:mortality*; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology