PP66. Endoluminal Infrarenal Aortic Aneurysm Repair: A Costly Endeavor for Low Risk Patients

Abstract

Since the FDA approval of endovascular aortic aneurysm repair (EVAR) devices, there has been a gradual transition from a physiologic to an anatomic criteria case selection. The economic implications of this evolving selection criteria have not been widely studied. The objective of this study is to investigate the cost-effectiveness of elective EVAR compared to OPEN abdominal aortic aneurysm (AAA) repair, in low and high risk patients. A retrospective analysis was performed reviewing all patients who underwent an elective AAA repair between 2004 and 2007. Clinical endpoints included postoperative stay, postoperative complications and 30-day mortality. Total hospital cost associated with the index procedure was obtained. The study population was divided into high (SVS score ≥ 8)and low risk (SVS score <8) surgical groups based on the SVS/AAVS medical comorbidity grading system. P < 0.05 was significant. During the study period, a total of 401 cases were identified, 43% (n = 173, SVS score 7.7 ± 0.25) EVAR and 57% (n = 228, SVS score 6.7 ± 0.32) OPEN. With the exception of ESRD (5.2%, n = 9 EVAR, 0% n = 0 OPEN, P < 0.01), the patient co-morbid profiles were not statistically different. Postoperative stay was less for EVAR (2.1 ± 0.2 days EVAR, 7.6 ± 0.4 days OPEN, P < 0.0001). For high risk patients (EVAR n = 88, OPEN n = 96), there was a trend towards higher 30-day mortality (1.1% EVAR vs 4.2% OPEN, P = 0.20) and a significantly higher complication rate (4.5% EVAR vs 15.6% OPEN, P = 0.013). The total hospital cost was significantly higher in the EVAR group ($35,903 ± 1156 EVAR vs $21,998 ± 1487 OPEN, P < 0.01). For the low risk cohort, there was no difference in morbidity and mortality despite higher total cost with EVAR ($33,758 ± 1120 EVAR vs $20,041 ± 1480 OPEN, P < 0.001). High risk OPEN AAA patients have a higher postoperative complication rate and show a trend in increased 30-day mortality compared to high risk EVAR patients. Low risk AAA repair patients exhibit a negligible difference between EVAR and OPEN regarding postoperative complications and mortality, which does not justify the significant healthcare cost difference between treatment groups. Based on these data, the policy of EVAR in low risk patients cannot be supported by clinical outcomes or financial measures.