Patient outcomes after open abdominal aortic aneurysm and endovascular aortic aneurysm repair have been widely reported from several large, randomized, controlled trials. It is not clear whether these trial outcomes are representative of abdominal aortic aneurysm repair procedures performed in real-world hospital settings across the United States. This study was designed to evaluate population-based outcomes after endovascular aortic aneurysm repair versus open abdominal aortic aneurysm repair using statewide inpatient databases and examine how they have helped improve our understanding of abdominal aortic aneurysm repair.
A systematic search of MEDLINE, EMBASE, and CINAHL databases was performed to identify articles comparing endovascular aortic aneurysm repair and open abdominal aortic aneurysm repair using data from statewide inpatient databases. This search was limited to studies published in the English language after 1990, and abstracts were screened and abstracted by 2 authors.
Our search yielded 17 studies published between 2004 and 2016 that used data from 29 different statewide inpatient databases to compare endovascular aortic aneurysm repair versus open abdominal aortic aneurysm repair. These studies support the randomized, controlled trial results, including a lower mortality associated with endovascular aortic aneurysm repair extended from the perioperative period up to 3 years after operation, as well as a higher complication rate after endovascular aortic aneurysm repair. The evidence from statewide inpatient database analyses has also elucidated trends in procedure volume, patient case mix, volume-outcome relationships, and health care disparities associated with endovascular aortic aneurysm repair versus open abdominal aortic aneurysm repair.
Population analyses of endovascular aortic aneurysm repair and open abdominal aortic aneurysm repair using statewide inpatient databases have confirmed short- and long-term mortality outcomes obtained from large, randomized, controlled trials. Moreover, these analyses have allowed us to assess the effect of endovascular aortic aneurysm repair adoption on population outcomes and patient case mix over time.
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- Progressive shortfall in open aneurysm experience for vascular surgery trainees with the impact of fenestrated and branched endovascular technology.J Vasc Surg. 2017; 65: 257-261
- Patient preference for surgical method of abdominal aortic aneurysm repair: postal survey.Eur J Vasc Endovasc Surg. 2010; 39: 55-61
- A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms.N Engl J Med. 2004; 351: 1607-1618
- Endovascular versus open repair of abdominal aortic aneurysm.N Engl J Med. 2010; 362: 1863-1871
- Endovascular repair of aortic aneurysm in patients physically ineligible for open repair.N Engl J Med. 2010; 362: 1872-1880
- Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial.BMJ. 2014; 348: f7661
- Long-term comparison of endovascular and open repair of abdominal aortic aneurysm.N Engl J Med. 2012; 367: 1988-1997
- Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: the EUROSTAR experience.J Vasc Surg. 2000; 32: 739-749
- Improved long-term survival after abdominal aortic aneurysm repair.Circulation. 2009; 120: 201-211
- Analysis of large databases in vascular surgery.J Vasc Surg. 2010; 52: 768-774
- The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.Ann Intern Med. 2009; : 151
- A statewide experience with endovascular abdominal aortic aneurysm repair: rapid diffusion with excellent early results.J Vasc Surg. 2004; 39: 10-19
- To what extent has endovascular aneurysm repair influenced abdominal aortic aneurysm management in the state of Illinois?.J Vasc Surg. 2005; 41: 568-574
- Variations in the utilization of endovascular aneurysm repair reflect population risk factors and disease prevalence.J Vasc Surg. 2010; 51: 801-809
- Trends, complications, and mortality in peripheral vascular surgery.J Vasc Surg. 2006; 43: 205-216
- Outcomes of endovascular treatment of ruptured abdominal aortic aneurysms.J Vasc Surg. 2006; 43: 453-459
- The value of linking hospital discharge and mortality data for comparative effectiveness research.J Comp Eff Res. 2013; 2: 175-184
- Evaluation of the effect of endovascular options on infrarenal abdominal aortic aneurysm repair.Am Surg. 2006; 72 (discussion704-6): 700-704
- Elective abdominal aortic aneurysm repair: relationship of hospital teaching status to repair type, resource use, and outcomes.J Am Coll Surg. 2009; 209: 356-363
- The incidence and factors associated with graft infection after aortic aneurysm repair.J Vasc Surg. 2008; 47: 264-269
- Longitudinal outcomes after endovascular repair of abdominal aortic aneurysms.Vasc Endovascular Surg. 2008; 42: 412-419
- Has the implementation of EVAR for ruptured AAA improved outcomes?.Vasc Endovascular Surg. 2009; 43: 252-257
- Differences in readmissions after open repair versus endovascular aneurysm repair.J Vasc Surg. 2013; 57: 89-95
- Transient postoperative atrial fibrillation after abdominal aortic aneurysm repair increases mortality risk.J Vasc Surg. 2016; 63: 1240-1247
- Survival after endovascular vs open aortic aneurysm repairs.JAMA Surg. 2015; 150: 1160-1166
- Reduction of in-hospital mortality among California hospitals meeting Leapfrog evidence-based standards for abdominal aortic aneurysm repair.J Vasc Surg. 2008; 47 (discussion 1163-4): 1155-1156
- AAA repair: sociodemographic disparities in management and outcomes.Vasc Endovascular Surg. 2008; 42: 555-560
- Issues in surgical randomized controlled trials.World J Surg. 1999; 23: 1210-1214
- Surgical practice is evidence based.Br J Surg. 1997; 84: 1220-1223
- Comparison of endovascular and open repair of ruptured abdominal aortic aneurysm in the United States in the past decade.Cardiovasc Intervent Radiol. 2014; 37: 337-342
- Surgical research using national databases.Ann Transl Med. 2016; 4: 393
Published online: February 24, 2017
Accepted: January 9, 2017
No sources of funding were used to undertake this systematic review or prepare this article.
Published by Elsevier Inc.