Variations in early outcomes of endovascular aneurysm repair with alternate endograft configurations.
BACKGROUND
Most endovascular abdomincal aortic aneurysm (AAA) repairs (EVARs) performed in the United States utilize a bifurcated configuration. The purpose of this study was to examine the effect of alternate graft configurations on early outcomes during EVAR.


METHODS
Patients in the National Surgical Quality Improvement Program (NSQIP) participant use file who underwent elective EVAR for AAA from 2005 to 2007 were stratified by configuration using CPT codes. Bifurcated configurations (CPT 34802, 34803, 34804) were compared to straight configurations such as tube or aortouni-iliac grafts (CPT 34800, 34805). Preoperative risk factors, intraoperative variables, 30-day outcome measures, and length of stay were compared. Composite morbidity included patients experiencing one or more of 21 complications defined by NSQIP protocol. Student's t-test and analyses of variance were used to compare variables.


RESULTS
There were 3,264 patients who underwent EVAR, including 2,864 bifurcated endografts and 400 straight endografts. Composite morbidity was greater in patients receiving straight endografts compared to those receiving bifurcated endografts (15.2% vs. 9.3%, p < 0.001). Length of stay was greater in the "straight" cohort as well (4.9 + or - 6.9 vs. 3.3 + or - 5.6, p < 0.001). There was a trend toward increased mortality in the "straight" cohort, but it did not reach statistical significance (2% vs. 0.9%, p = 0.054). After controlling for the top 11 NSQIP predictors of mortality in vascular patients, graft configuration remained significant in the multivariable analysis for morbidity (odds ratio [OR] = 1.55, 95% confidence interval [CI[ 1.13-2.12, p = 0.006) and length of stay but not mortality (OR = 1.63, 95% CI 0.70-3.80, p = 0.263).


CONCLUSIONS
EVAR using a tube or aortouni configuration is associated with increased complications and length of stay. These poorer outcomes may be related to factors that lead surgeons to choose these approaches.
O'Keeffe
Shane D
SD
University of Kentucky Medical Center, 800 Rose Street, Room C217, Lexington, KY 40536, USA.
Davenport
Dan
D
Endean
Eric D
ED
Xenos
Eleftherios S
ES
Sorial
Ehab E
EE
Minion
David J
DJ
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D019992:Databases as Topic; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome