Portelli Tremont Jaclyn N, Cha Andrew, Dombrovskiy Viktor Y, Rahimi Saum A
Division of Vascular Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
Division of Vascular Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Vasc Endovascular Surg. 2016 Apr;50(3):147-55. doi: 10.1177/1538574416637442. Epub 2016 Mar 13.
Ruptured abdominal aortic aneurysm (rAAA) remains a critical diagnosis, and research is needed to address outcomes following surgical repair. The purpose of this study was to compare nationwide outcomes for patients who received either endovascular repair (EVAR) or open surgical repair (OSAR) for rAAA.
The Medicare Provider Analysis and Review file from 2005 to 2009 was used to identify patients diagnosed with rAAA and treated with either EVAR or OSAR. Those patients with both procedures were excluded. Primary outcomes included mortality, postoperative complications, and readmission rates. Secondary outcomes included hospital resource utilization and length of stay (LOS).
A total of 8480 patients with rAAA who underwent EVAR (n = 1939) or OSAR (n = 6541) were identified. On multivariate regression, the likelihood of dying in the hospital after OSAR compared to EVAR was significantly greater (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.74-2.18). There was significantly greater frequency of postoperative complications after OSAR compared to EVAR (OR = 2.1, 95%CI = 1.86-2.37, P < .0001). Freedom from readmission after OSAR was significantly greater than that after EVAR. Total hospital cost for all services after EVAR was greater than that after OSAR (US$100 875 vs US$89 035; P < .0001), but intensive care unit (ICU) cost for EVAR was significantly less than that for OSAR (US$5516 vs US$8600; P < .0001). Total hospital and ICU LOS were shorter in EVAR compared to OSAR (P < .0001 for both).
EVAR for rAAA has shown mortality benefits over OSAR as well as reduced ICU and total LOS. This data suggest EVAR is associated with a greater survival benefit, fewer postoperative complications, and may help improve hospital resource utilization.
腹主动脉瘤破裂（rAAA）仍然是一种危急病症，需要开展研究以探讨手术修复后的治疗效果。本研究的目的是比较接受血管腔内修复术（EVAR）或开放手术修复术（OSAR）治疗的rAAA患者在全国范围内的治疗效果。
使用2005年至2009年医疗保险提供者分析与审查文件，确定诊断为rAAA并接受EVAR或OSAR治疗的患者。排除接受过两种手术的患者。主要结局包括死亡率、术后并发症和再入院率。次要结局包括医院资源利用情况和住院时间（LOS）。
共识别出8480例接受EVAR（n = 1939）或OSAR（n = 6541）治疗的rAAA患者。多因素回归分析显示，与EVAR相比，OSAR术后院内死亡的可能性显著更高（优势比[OR]=1.95；95%置信区间[CI]=1.74 - 2.18）。与EVAR相比，OSAR术后并发症的发生频率显著更高（OR = 2.1，95%CI = 1.86 - 2.37，P <.0001）。OSAR术后无再入院的情况显著优于EVAR。EVAR术后所有服务的总住院费用高于OSAR（100875美元对89035美元；P <.0001），但EVAR的重症监护病房（ICU）费用显著低于OSAR（5516美元对8600美元；P <.0001）。与OSAR相比，EVAR的总住院时间和ICU住院时间更短（两者P均<.0001）。
rAAA的EVAR与OSAR相比，已显示出在死亡率方面的优势，以及ICU和总住院时间的缩短。这些数据表明，EVAR与更大的生存获益、更少的术后并发症相关，并且可能有助于改善医院资源利用。
