A population-based analysis of endovascular versus open thoracic aortic aneurysm repair

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 X-2 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 [0], 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. (J Vasc Surg 2009;49:1112-6.)