title: Characterizing the evolution of perioperative outcomes and costs of endovascular abdominal aortic aneurysm repair.
abstract: OBJECTIVE
  The purpose of this study is to characterize the evolution in perioperative outcomes and costs of endovascular abdominal aortic aneurysm (AAA) repair (EVAR) by detailing changes in adjusted outcomes and costs over time.
  
  
  METHODS
  National Inpatient Sample (2000-2011) data were used to evaluate patient characteristics, outcomes, and perioperative costs for elective EVAR performed for intact AAA. Outcomes were adjusted for patient demographics and comorbidities, and hospital factors by multivariate analysis. Costs were calculated from hospital cost to charge ratio files and adjusted to 2011 dollars.
  
  
  RESULTS
  From 2000 to 2011, 185,249 patients underwent elective EVAR for intact AAA. The absolute rates of in-hospital major morbidity, mortality, and procedural costs all decreased significantly over time (P < .0001). The prevalence of major comorbidities in patients undergoing EVAR, including obesity, diabetes, and dyslipidemia, all increased significantly over time. After adjusting for multiple demographics, comorbidities, and hospital-level factors, recent outcomes of EVAR (2009-2011) remain superior to the early experience (2000-2002) with respect to mortality and major complications.
  
  
  CONCLUSIONS
  From 2000-2011, the perioperative outcomes of EVAR improved significantly despite a higher prevalence of comorbidities among patients undergoing repair. Concurrently, procedure-associated costs declined. Advanced technology is often implicated in escalating healthcare spending, and the value of novel techniques is often questioned. These findings highlight that, in the case of EVAR, procedural outcomes have improved while the initial costs of repair have declined over time. EVAR offers an interesting example for stakeholders to consider in the era of cost-containment pressures and criticism of nascent, expensive technology in healthcare.
authors.affiliation: Department of Surgery, Weill Cornell Medical College, New York, NY.
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Salzler
authors.affiliation: Department of Surgery, Weill Cornell Medical College, New York, NY. Electronic address: ajm9007@med.cornell.edu.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Meltzer
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY.
authors.forename: Jialin
authors.initials: J
authors.lastname: Mao
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY.
authors.forename: Abby
authors.initials: A
authors.lastname: Isaacs
authors.affiliation: Department of Surgery, Weill Cornell Medical College, New York, NY.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Connolly
authors.affiliation: Department of Surgery, Weill Cornell Medical College, New York, NY.
authors.forename: Darren B
authors.initials: DB
authors.lastname: Schneider
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY.
authors.forename: Art
authors.initials: A
authors.lastname: Sedrakyan
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D015897:Comorbidity; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D005260:Female; D017722:Hospital Charges / Q000639:trends*; D017721:Hospital Costs / Q000639:trends*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D011183:Postoperative Complications / Q000191:economics / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology