A Comparison of Endovascular Repair Versus Open Repair of Abdominal Aortic Aneurysms in a Community Setting

Objective: To compare outcomes between endovascular versus surgical repair of abdominal aortic aneurysms (AAA) in a community hospital setting. Methods: A retrospective analysis of all patients undergoing repair of AAA during 2007. Inclusion criteria included stability and anatomic suitability for endovascular repair (EVAR). Data analyzed included comorbidity, length of stay, complications, and cost to the hospital. Results: Thirty-one endovascular and 12 open cases fit criteria. There were no significant differences in mortality risk, size of aneurysm, or age between the groups (endovascular 71.6 +/- 8 years vs. open 66.7 +/- 9 years, P +/- 0.07). The endovascular group included three patients with contained retroperitoneal rupture, one of whom died secondary to visceral embolization and thrombosis (the only mortality). EVAR was performed with local anesthesia in three and spinal in three cases. Twenty-three cases were performed completely percutaneously. There were no deaths in the surgical group, but four patients experienced major complications. There was no difference between groups in terms of "contribution" costs, but EVAR had significantly greater cost/benefit when measuring "fully loaded"costs (endovascular 4436 +/- 7418$ vs. open -1418 +/- 6756$, P=0.02). Endovascular was associated with significantly shorter intensive care unit stay (1.3 +/- 0.7 days vs. 2.8 +/- 2.1 days, P=0.001) and overall stay (2.5 +/- 2.1 days vs. 7.2 +/- 1.6 days, P=0.001). Conclusions: Endovascular of AAA seems to be at least equivalent to open repair in terms of acute outcomes, with much improved cost/benefit predominantly linked to reduced length of stay.