title: Epidemiology of aortic aneurysm repair in the United States from 2000 to 2010.
abstract: OBJECTIVE
  Broad application of endovascular aneurysm repair (EVAR) has led to a rapid decline in open aneurysm repair (OAR) and improved patient survival, albeit at a higher overall cost of care. The aim of this report is to evaluate national trends in the incidence of unruptured and ruptured abdominal aortic aneurysms (AAAs), their management by EVAR and OAR, and to compare overall patient characteristics and clinical outcomes between these two approaches.
  
  
  METHODS
  A retrospective analysis of the cross-sectional National Inpatient Sample (2000-2010) was used to evaluate patient characteristics and outcomes related to EVAR and OAR for unruptured and ruptured AAAs. Data were extrapolated to represent population-level statistics through the use of data from the U.S. Census Bureau. Comparisons between groups were made with the use of descriptive statistics.
  
  
  RESULTS
  There were 101,978 patients in the National Inpatient Sample affected by AAAs over the 11-year span of this study; the average age was 73 years, 21% were women, and 90% were white. Overall in-hospital mortality rate was 7%, with a median length of stay (LOS) of 5 days and median hospital charges of $58,305. In-hospital mortality rate was 13 times greater for ruptured patients, with a median LOS of 9 days and median charges of $84,744. For both unruptured and ruptured patients, EVAR was associated with a lower in-hospital mortality rate (4% vs 1% for unruptured and 41% vs 27% for ruptured; P < .001 for each), shorter median LOS (7 vs 2; 9 vs 6; P < .001) but a 27%-36% increase in hospital charges.
  
  
  CONCLUSIONS
  The overall use of EVAR has risen sharply in the past 10 years (5.2% to 74% of the total number of AAA repairs) even though the total number of AAAs remains stable at 45,000 cases per year. In-hospital mortality rates for both ruptured and unruptured cases have fallen by more than 50% during this time period. Lower mortality rates and shorter LOS despite a 27%-36% higher cost of care continues to justify the use of EVAR over OAR. For patients with suitable anatomy, EVAR should be the preferred management of both ruptured and unruptured AAAs.
authors.affiliation: Center for Translational Injury Research (CeTIR), Department of Surgery, University of Texas-Houston, Houston, Tex; Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisc.
authors.forename: Anahita
authors.initials: A
authors.lastname: Dua
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisc.
authors.forename: SreyRam
authors.initials: S
authors.lastname: Kuy
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisc.
authors.forename: Cheong J
authors.initials: CJ
authors.lastname: Lee
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Va.
authors.forename: Gilbert R
authors.initials: GR
authors.lastname: Upchurch
authors.affiliation: Department of Surgery, Duke University, Durham, NC. Electronic address: sapan.desai@surgipshere.com.
authors.forename: Sapan S
authors.initials: SS
authors.lastname: Desai
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology / Q000601:surgery*; D001019:Aortic Rupture / Q000453:epidemiology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000706:statistics & numerical data / Q000639:trends*; D003430:Cross-Sectional Studies; D057510:Endovascular Procedures / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology