Long Term Mortality and Reintervention Following Repair of Ruptured Abdominal Aortic Aneurysms using VQI Matched Medicare Claims.
Academic Article
Overview
abstract
OBJECTIVE: To compare endovascular aortic aneurysm repair (EVAR) versus open aortic repair (OAR) on mortality and reintervention after ruptured infrarenal abdominal aortic aneurysm (rAAA) repair in the Vascular Quality Initiative (VQI). BACKGROUND: The optimal treatment modality for rAAA remains debated with little data on long-term comparisons. METHODS: VQI rAAA repairs (2004-2018) were matched with Medicare claims (VQI-VISION). Primary outcomes were in-hospital and long-term mortality. Secondary outcome was reintervention. Inverse probability weighting (IPW) was used to adjust for treatment selection and Cox Proportional Hazards models, and negative binomial regressions were used for analysis. Landmark analysis was performed among patients surviving hospital discharge. RESULTS: Among 1,885 VQI/Medicare rAAA patients, 790 underwent OAR and 1,095 underwent EVAR. Median age 76 years; 73% were male. IPW produced comparable groups. In-hospital mortality was lower after EVAR versus OAR (21% vs. 37%, OR 0.52, 95%CI 0.4-0.7). One-year mortality rates were lower for EVAR versus OAR (HR 0.74, 95%CI 0.6-0.9), but not statistically different after one year (HR 0.95, 95%CI 0.8-1.2). This implies additional benefit to EVAR in the short term. Reintervention rates were higher after EVAR than OAR at 2 and 5-years (RR 1.79 95%CI 1.2-2.7 and RR 2.03 95%CI 1.4-3.0), but not within the first year. Reintervention was associated with higher mortality risk for both OAR (HR 1.66 95%CI 1.1-2.5) and EVAR (HR 2.14 95%CI 1.6-2.9). Long-term mortality was similar between repair types (HR 0.99, 95%CI 0.8-1.2). CONCLUSIONS: Within VQI/Medicare patients undergoing rAAA repair, the perioperative mortality rate favors EVAR but equalizes after one year. Reinterventions were more common following EVAR and were associated with higher mortality regardless of treatment.
