Expanding use of emergency endovascular repair for ruptured abdominal aortic aneurysms: disparities in outcomes from a nationwide perspective.
BACKGROUND
Endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) has become widely accepted in the elective setting but remains controversial for emergency repair of ruptured aneurysms (rAAA). We sought to examine the national trends in use and associated outcomes with EVAR.


METHODS
The Nationwide Inpatient Sample (NIS) was used to analyze all admissions for rAAA from 2001 through 2004. Nationwide temporal trends and demographics using weighted samples were evaluated. Focused univariate and multivariate analyses comparing outcomes from open repair and EVAR were done for the years 2003 and 2004.


RESULTS
There were 28,123 admissions for rAAA, with a stepwise decline in admissions from 2001 to 2004. Use of EVAR increased significantly from 6% of all emergency repairs in 2001 to 11% in 2004 (P < .01). Mortality for EVAR declined significantly from 43% to 29% (P < .01), but mortality with open repair showed no change (40% to 43%). From the 2003 to 2004 data set, 949 EVAR and 8982 open repairs were identified. Compared with open repair, the EVAR patients had lower mortality (31% vs 42%), shorter hospital stay (6 vs 9 days), and were more likely to be discharged to home (59% vs 37%, all P < .01). The total hospital charges for EVAR and open repair were similar (dollars 71,428 vs $74,520, P = .59). Mortality for EVAR was significantly higher at nonteaching hospitals compared with teaching centers (55% vs 21%, P < .01) and at nonteaching centers, even exceeding that of open repair (46%). Regression modeling confirmed the overall benefits of EVAR as well as the worse outcomes at nonteaching facilities after adjusting for patient comorbidities, disease severity, and hospital or system covariates.


CONCLUSIONS
Endovascular repair is being increasingly used in the emergency management of ruptured AAA, with steadily decreasing mortality during the study period. Endovascular AAA repair is associated with improved mortality and outcomes compared with open repair, but results in nonteaching centers are substantially worse than those in teaching hospitals.
Lesperance
Kelly
K
Department of Surgery, Madigan Army Medical Center, Tacoma, WA 98431, USA. kelly.e.lesperance@us.army.mil
Andersen
Charles
C
Singh
Niten
N
Starnes
Benjamin
B
Martin
Matthew J
MJ
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications* / Q000191:economics / Q000401:mortality / Q000601:surgery; D001019:Aortic Rupture / Q000191:economics / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D004638:Emergency Treatment / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000191:economics / Q000706:statistics & numerical data*; D017722:Hospital Charges / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D013503:Surgery Department, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends; D016526:Workload / Q000706:statistics & numerical data