Adoption of Endovascular Repair of Abdominal Aortic Aneurysm in California: Lessons for Future Dissemination of Surgical Technology

Chang, David C.; Easterlin, Molly C.; Montesa, Christine; Kaushal, Kalpana; Wilson, Samuel E.

doi:10.1016/j.avsg.2011.08.022

Cited by 10 publications

(3 citation statements)

References 16 publications

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“…[1][2][3] Numerous studies have identified that EVAR is associated with reduced perioperative mortality, morbidity, and length of stay and higher postoperative quality of life. [4][5][6][7][8][9] This favorable perioperative risk profile, in comparison to open aneurysm repair, has resulted in swift and widespread acceptance of EVAR.…”

mentioning

confidence: 99%

Characterizing the evolution of perioperative outcomes and costs of endovascular abdominal aortic aneurysm repair

Salzler

Meltzer

Mao

et al. 2015

Journal of Vascular Surgery

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From 2000-2011, the perioperative outcomes of EVAR improved significantly despite a higher prevalence of comorbidities among patients undergoing repair. Concurrently, procedure-associated costs declined. Advanced technology is often implicated in escalating healthcare spending, and the value of novel techniques is often questioned. These findings highlight that, in the case of EVAR, procedural outcomes have improved while the initial costs of repair have declined over time. EVAR offers an interesting example for stakeholders to consider in the era of cost-containment pressures and criticism of nascent, expensive technology in healthcare.

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mentioning

confidence: 99%

Characterizing the evolution of perioperative outcomes and costs of endovascular abdominal aortic aneurysm repair

Salzler

Meltzer

Mao

et al. 2015

Journal of Vascular Surgery

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“…1 Since Parodi's initial report, endovascular aortic aneurysm repair (EVAR) has become the standard of care for infrarenal AAA for most surgeons. 2,3 Coincident with this transition to endovascular AAA repair, follow-up care and monitoring of endovascular grafts have posed unique challenges for vascular surgeons and health care systems. Although EVAR reduces perioperative morbidity and mortality associated with AAA repair, surveillance for intermediate-and long-term complications (including thrombosis, endoleak, migration, and delayed rupture) is essential and can be problematic.…”

mentioning

confidence: 99%

A multiregional registry experience using an electronic medical record to optimize data capture for longitudinal outcomes in endovascular abdominal aortic aneurysm repair

Hye

Inui

Anthony³

et al. 2015

Journal of Vascular Surgery

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Leveraging an EMR provides a robust platform for monitoring short-term and midterm outcomes after abdominal aortic aneurysm repair. Use of standardized templates in the EMR allows data entry as part of normal workflow, improving compliance, accuracy, and data capture using limited but expert personnel. Assessment of patient demographics, device performance, practice variation, and postoperative outcomes benefits clinical decision-making by providing complete and adjudicated event reporting. The findings from this large, community-based EVAR registry augment other studies limited to perioperative and short-term outcomes or small patient cohorts.

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“…Endovascular aneurysm repair (EVAR) has been a rapidly adopted technology with lower morbidity and mortality compared with open surgical repair (OSR) of abdominal aortic aneurysms (AAAs) in both randomized and non-randomized studies. 1 – 4 Endovascular aneurysm repair also offers the advantage of a shortened hospital length of stay (LOS) and has surpassed OSR in terms of procedure volume. 1 , 5 The value gained from lower morbidity, mortality, and LOS is met with high endografts’ costs, imaging surveillance costs, and reintervention rates.…”

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confidence: 99%

Feasibility and Cost Analysis of Ambulatory Endovascular Aneurysm Repair

et al. 2022

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Purpose: We sought to compare the costs of ambulatory endovascular aneurysm repair (a-EVAR) and inpatient EVAR (i-EVAR) at up to 1-year of follow-up. Materials and Methods: A retrospective cohort study of consecutive patients undergoing elective EVAR between April 2016 and December 2018 at two academic centers. Patients planned for a-EVAR were compared with i-EVAR. Costs at 30 days and 1 year were extracted. These included operating room (OR) use, bed occupancy, laboratory and imaging, emergency department (ED) visits, readmissions, and reinterventions. Baseline characteristics were compared. Multiple regression model was used to identify predictors of increased EVAR costs. Repeated measures analysis of variance (ANOVA) was used to compare cost differences at 30 days and 1 year via an intention-to-treat analysis. Bonferroni post hoc test compared between-group differences. A p value<0.05 was considered statistically significant. Results: One hundred seventy patients were included. Most underwent percutaneous EVAR (>94%) under spinal anesthesia (>84%). Ambulatory endovascular aneurysm repair was successful in 84% (84/100). Ambulatory endovascular aneurysm repair patients (76±8 years) were younger than i-EVAR (78±9 years). They also had a smaller mean aneurysm diameter (56±6 mm) compared with i-EVAR (59±6 mm). Emergency department visits, readmissions, and reinterventions were similar up to 1 year (all p=NS). Ambulatory endovascular aneurysm repair costs showed a non-statistically significant reduction in total costs at 30 days and 1 year by 27% and 21%, respectively. Patients younger than 85 years and males had a 30-day cost reduction by 34% (p=0.027) and 33% (p=0.035), respectively with a-EVAR. Conclusions: Same-day discharge is feasible and successful in selected patients. Patients younger than 85 years and males have a short-term cost benefit with EVAR done in the ambulatory setting without increased complications or reinterventions. Clinical Impact This study shows the overall safety of ambulatory EVAR with proper patient selection. These patient had similar post-intervention complications to inpatients. Same day discharge also resulted in short-term reduction in costs in male patients and patients younger than 85 years.

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Adoption of Endovascular Repair of Abdominal Aortic Aneurysm in California: Lessons for Future Dissemination of Surgical Technology

Cited by 10 publications

References 16 publications

Characterizing the evolution of perioperative outcomes and costs of endovascular abdominal aortic aneurysm repair

Characterizing the evolution of perioperative outcomes and costs of endovascular abdominal aortic aneurysm repair

A multiregional registry experience using an electronic medical record to optimize data capture for longitudinal outcomes in endovascular abdominal aortic aneurysm repair

Feasibility and Cost Analysis of Ambulatory Endovascular Aneurysm Repair

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