In-hospital Mortality Risk after Endovascular and Open Aortic Aneurysm Repairs for Ruptured Abdominal Aortic Aneurysms

Abstract

IntroductionObservational studies demonstrate reduced mortality after endovascular (EVAR) compared to open aneurysm repair (OAR) for ruptured abdominal aortic aneurysms (rAAA). We sought to determine national trends in repair type and in-hospital mortality rates for rAAA. MethodsWe analyzed patients with rAAA managed with OAR or EVAR from 2002 to 2020 in the National Inpatient Sample and evaluated annual trends in volume and in-hospital mortality by repair type. Multilevel mixed effects logistic regression model was fit for patient and system-level risk adjustment. We assessed interactions between time, sex, and Elixhauser index with repair type. ResultsWe examined 13,376 patients with rAAA. 8,357 (62.5%) underwent OAR. Patients receiving EVAR were slightly older (73.7 vs 72.5 years; p<0.001) with slightly higher mean Elixhauser index (4.0 vs 3.8; p<0.001). Unadjusted in-hospital mortality was 37.4% vs. 22.4% for OAR and EVAR respectively. EVAR offered a risk-adjusted survival advantage (OR: 0.39, 95% CI: 0.32, 0.46). There was a statistically significant reduction of in-hospital mortality over time in the EVAR group (interaction OR = 0.96, 95% CI: 0.95, 0.98). The interaction between Elixhauser index and repair was not statistically significant (interaction OR: 0.95, 95% CI: 0.87, 1.05). ConclusionsSurvival rates for OAR and EVAR improved over time. EVAR persistently provided a substantial survival advantage over OAR in patients with rAAA over the past two decades.