Print this pageEarly Outcomes Of Endovascular Versus Open Abdominal Aortic Aneurysm Repair In the National Surgical Quality Improvement Program--Private Sector (NSQIP-PS)
1Massachusetts General Hospital, Boston, MA;2Massachusetts General Hospital, Boston, MA;3Massachusetts General Hospital, Boston, MA;4VA Boston Healthcare System, West Roxbury, MA;5Denver VA Medical Center, Aurora, CO
Background: There remains no consensus on the appropriate application of endovascular abdominal aortic aneurysm repair (EVAR). In the absence of randomized trials, information from administrative databases, industry-sponsored trials, and single institutions has inherent deficiencies. This study was designed to compare early outcomes of open (OPEN) versus EVAR in a contemporary (2000-2003) large multi-center prospective cohort.
Methods: Fourteen academic medical centers contributed data to the NSQIP-PS which ensures uniform, comprehensive, prospective, and previously validated data entry by trained independent nurse reviewers. A battery of clinical and demographic features was assessed with multivariate analysis for association with the principal study endpoints of 30-day operative mortality and morbidity.
Results: 1042 patients underwent elective infrarenal AAA repairs: 460 EVAR and 582 OPEN. EVAR patients were older (74 vs. 71 years, p<0.0001), included more males (84.6% vs. 79.6%, p<0.05), and had a higher incidence of COPD (25.4% vs. 17.9%, p<0.01). There was no significant difference in the crude mortality rate between EVAR and OPEN, 2.83% vs. 3.95% respectively (p = 0.32). EVAR, however, resulted in significantly reduced overall morbidity (27% vs. 41%, p<0.001) and hospital stay (4 vs. 9 days, p<0.0001). Cardiopulmonary and renal function-related comorbidities had the expected significant impact on mortality for both procedures at univariate analysis (p<0.05). Multivariate correlates of operative mortality included OPEN (OR 2.44, 95% CI: 1.03-5.78, p<0.05), advanced age (OR 1.11, p<0.001), angina (OR 5.54, p<0.01), poor functional status (OR 5.78, p<0.001), weight loss (OR 7.42, p<0.01), and preoperative dialysis (OR 51.4, p<0.0001). EVAR also compared favorably to OPEN (OR 2.01, 95% CI: 1.49-2.70, p<0.0001) for overall morbidity.
Conclusion: Significant morbidity accompanies AAA repair, even at major academic medical centers. These data strongly endorse EVAR as the preferred approach especially in the presence of significant cardiopulmonary and renal comorbidities and poor preoperative functional status.