A population-based analysis of endovascular versus open thoracic aortic aneurysm repair
Presented at the Society for Clinical Vascular Surgery Annual Meeting, Las Vegas, Nev, Mar 7, 2008.
Received 17 September 2008; accepted 9 December 2008. published online 23 March 2009.
Objective
The perioperative outcomes of open surgical and endovascular repair of intact thoracic aortic aneurysms (TAAs) during the last 3 months of 2005 were compared using a national administrative database.
Methods
The Nationwide Inpatient Sample was used to identify patients undergoing open aneurysm repair (OAR) or endovascular TAA repair (TEVAR) from October 1 to December 31, 2005. Patient demographic data, length of stay, hospital charges, patient disposition, and mortality were examined. Where appropriate, univariate tests of association used the χ2 test, and multiple logistic regression analysis was used to determine predictors of in-hospital mortality, complications, and discharge status.
Results
A total of 1030 patients underwent open TAA repair and 267 underwent TEVAR. There was no significant difference in mortality between OAR and TEVAR (adjusted odds ratio [OR], 1.2; 95% confidence interval [CI], 0.73-2.12), although OAR patients were more likely to have cardiac, respiratory, and hemorrhagic complications. Patients undergoing TEVAR were more likely to be discharged to home (adjusted OR, 6.37; 95% CI, 2.93-13.70) and had a decreased length of stay (5.7 days vs 9.9 days; P = .0015). The differences in hospital charges and costs were not significant.
Conclusion
Although further study is warranted, this study of a national sample suggests that endovascular TAA repair is safe in the short-term, associated with fewer cardiac, respiratory, and hemorrhagic complications, and requires a shorter hospital stay.
aDepartment of Surgery, University of Michigan Medical School, Ann Arbor, Mich
bSection of General Surgery, University of Michigan Medical School, Ann Arbor, Mich
cSection of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Mich
dSection of Vascular Surgery, University of Michigan Medical School, Ann Arbor, Mich
Reprint requests: Gilbert R. Upchurch Jr, MD, Section of Vascular Surgery, CVC 5463, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5867
ABSTRACT