title: Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm Results in Higher Hospital Expenses than Open Surgical Repair: Evidence from a Tertiary Hospital in Brazil.
abstract: BACKGROUND
  Endovascular aneurysm repair (EVAR) has become the preferred approach for the treatment of infrarenal abdominal aortic aneurysm (IRAAA) in detriment of open surgical repair (OSR). EVAR results in lower mortality rates within 30 days, but rates tend to be the same after longer periods. Moreover, reduced use of hospital resources with EVAR does not necessarily offset the costs of the endoprosthesis. We aimed, in this study, to estimate hospital expenses after OSR or EVAR, including early and late readmissions.
  
  
  METHODS
  Retrospective analysis of hospital expenses (2005-2012) with elective IRAAA surgeries performed in a tertiary hospital, including 127 patients divided into 2 groups, EVAR (n = 102) and OSR (n = 25).
  
  
  RESULTS
  One perioperative death occurred in each group. EVAR interventions lasted 145 vs. 210 min of OSR (P < 0.001). Among OSR patients, 68% required packed red blood cells. Among EVAR patients, this proportion was 7.8% (P < 0.001). Median hospitalization time differed significantly for EVAR (4 days) and OSR (8 days; P < 0.001, intervals EVAR: 1-17 days, OSR: 2-442 days). The median and mean expenses with EVAR were US $53,080.95 and US $56,289.49, respectively. The median and mean expenses with OSR were US $37,116.04 and US $68,788.54, respectively. Early readmissions reached 11.2%. None of the OSR patients required late reinterventions, but 10 (9.9%) EVAR patients did, one of whom died.
  
  
  CONCLUSIONS
  EVAR resulted in higher expenses with the exclusion of one outlier. Late reinterventions, with elevated costs, were only required by EVAR patients. Thus, when patients are eligible to undergo either intervention, OSR seems to have lower costs and better long-term results.
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, Brazil. Electronic address: dr.marcelo@consultoriovasculares.med.br.
authors.forename: Marcelo Passos
authors.initials: MP
authors.lastname: Teivelis
authors.affiliation: Health Economics' Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Daniel Tavares
authors.initials: DT
authors.lastname: Malheiro
authors.affiliation: Health Economics' Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Marcio
authors.initials: M
authors.lastname: Hampe
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Marcelo Bellini
authors.initials: MB
authors.lastname: Dalio
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Nelson
authors.initials: N
authors.lastname: Wolosker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000191:economics* / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000191:economics; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation / Q000401:mortality; D001938:Brazil; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation / Q000401:mortality; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D015607:Stents / Q000191:economics; D062606:Tertiary Care Centers / Q000191:economics*; D013997:Time Factors; D016896:Treatment Outcome