Open versus endovascular abdominal aortic aneurysm repair in Medicare beneficiaries

Sarah E Deery, Marc L Schermerhorn, Sarah E Deery, Marc L Schermerhorn

Abstract

Abdominal aortic aneurysms are relatively common and often life-threatening, with especially high mortality after aneurysm rupture. The introduction of endovascular aneurysm repair, a minimally invasive alternative to traditional open repair, led to decreased mortality and morbidity in randomized controlled trials, but these trials were conducted in highly selected patients and providers and were underpowered to detect differences in rare adverse events throughout follow-up. With observational studies of Medicare beneficiaries, we demonstrate that the randomized trial results are generalizable to the majority of patients undergoing abdominal aortic aneurysm repair in the United States. Additionally, with a larger cohort, comparative analyses evaluating rare, previously unstudied late outcomes such as laparotomy-related complications, late reinterventions, mortality with reinterventions, and late rupture could be conducted. Furthermore, trends in management over time and relationships between surgeon and hospital volume and outcomes can be studied. The goal of this review was to summarize the existing literature regarding abdominal aortic aneurysms among Medicare beneficiaries and to evaluate the benefits and limitations of administrative claims data in comparative effectiveness research.

Copyright © 2017 Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Bi-weekly death rates through one year in US Medicare beneficiaries undergoing open and endovascular abdominal aortic aneurysm repair from 2001 to 2004 (from Schermerhorn et al., JACS 2011; with permission from Elsevier).
Figure 2
Figure 2
Freedom from rupture, aneurysm-related reintervention, or laparotomy-related reintervention (from Schermerhorn et al., NEJM 2015; with permission from the Massachusetts Medical Society).
Figure 3
Figure 3
Long-term survival in Medicare beneficiaries with and without reinterventions after initial open or endovascular aneurysm repair (from Giles et al., J Vasc Surg 2011; with permission from Elsevier).
Figure 4
Figure 4
Late survival amongst Medicare beneficiaries undergoing EVAR versus open repair, after excluding those patients who experienced late rupture or reintervention.
Figure 5
Figure 5
Short-term AAA-related deaths per 100,000 US Medicare beneficiaries (age and gender adjusted), 1995–2008 (from Schermerhorn et al., Ann Surg 2012; with permission from Wolters Kluwer Health, Inc.).
Figure 6
Figure 6
Operative mortality for EVAR, open repair, and total AAA repairs for US Medicare beneficiaries, 1995–2008, in A) intact AAA, and B) ruptured AAA (from Schermerhorn et al., Ann Surg 2012; with permission from Wolters Kluwer Health, Inc.).

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