Long-term outcomes and resource utilization of endovascular versus open repair of abdominal aortic aneurysms in Ontario

Jetty, Prasad; Hébert, Paul C.; Walraven, Carl van

doi:10.1016/j.jvs.2009.10.101

Cited by 29 publications

(18 citation statements)

References 35 publications

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“…However, several investigators have included readmission in composite outcomes of aneurysm repair involving reoperation or mortality, 14 or studied readmission over longer time intervals such as 6 to 12 months. 14–17 In one prior study, Vogel and colleagues analyzed a Washington State hospital administrative discharge database and found 30-day readmission rates of 11.6% for EVAR and 13.1% for open repair. 18 These readmission rates were similar to our findings of 13.3% and 12.8%, respectively, in National Medicare beneficiaries.…”

Section: Discussionmentioning

confidence: 99%

Causes and Implications of Readmission After Abdominal Aortic Aneurysm Repair

et al. 2012

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Objective To determine the frequency, causes, predictors, and consequences of 30-day readmission after abdominal aortic aneurysm (AAA) repair. Summary Background Data CMS will soon reduce total Medicare reimbursements for hospitals with higher-than-predicted 30-day readmission rates after vascular surgical procedures including AAA repair. However, causes and factors leading to readmission in this population have never before been systematically analyzed. Methods We analyzed elective AAA repairs over a two-year period from the CMS Chronic Conditions Warehouse, a 5% national sample of Medicare beneficiaries. Results 2481 patients underwent AAA repair – 1502 endovascular (EVAR) and 979 open. 30-day readmission rates were equivalent for EVAR (13.3%) and open repair (12.8%). While wound complication was the most common reason for readmission after both procedures, the relative frequency of other causes differed – e.g., bowel obstruction was common following open repair and graft complication after EVAR. In multivariate analyses, preoperative comorbidities had a modest effect on readmission; however, postoperative factors including serious complications leading to prolonged length of stay and discharge destination other than home had a profound influence on the probability of readmission. The one-year mortality in readmitted patients was 23.4% versus 4.5% in those not readmitted (p<0.001). Conclusions Early readmission is common after AAA repair. Adjusting for comorbidities, postoperative events predict readmission, suggesting that proactively preventing, detecting, and managing postoperative complications may provide an approach to decreasing readmissions, with the potential to reduce cost and possibly enhance long-term survival.

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Section: Discussionmentioning

confidence: 99%

Causes and Implications of Readmission After Abdominal Aortic Aneurysm Repair

et al. 2012

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“…Endovascular procedures in general cost more than classic open surgery because of increased costs related to stents using or the need of other supplementary procedures. 9 In Ontario, EVAR service is funded in only six vascular surgery centers with a fixed limit on the number of endovascular abdominal aortic aneurysm repairs that are funded annually.…”

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confidence: 99%

Trends in abdominal aortic aneurysm repair in the era of endovascular technology in Ontario

Altoijry

Mamdani

Al‐Omran

2011

Journal of Vascular Surgery

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“…The short-and mid-term outcomes of EVAR have been improving with recent technical and technological advances, and many reports have mentioned the superiority of this low-invasive surgery compared with open repair of AAAs [10][11][12][20][21][22]. However, EVAR is not applicable to all of AAAs, and the IFU for each device are dependent on the morphology of the aneurysm.…”

Section: Discussionmentioning

confidence: 99%

A one-stage operation for abdominal aortic aneurysm and intraductal papillary mucinous neoplasms of the pancreas: report of a case

Tsuji¹,

Kitano²,

Sawada³

2012

Surg Today

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Pancreatic surgery concomitant with abdominal aortic repair is rarely chosen due to concerns about prosthetic infection following pancreatic leakage and the poor prognosis of pancreatic neoplasms. We herein report a successfully treated case of infrarenal abdominal aortic aneurysm and intraductal papillary mucinous neoplasms of the pancreas treated by a one-stage operation. A 75-year-old male with a history of cerebral infarction and chronic subdural hematoma was referred to our department with a pulsatile abdominal mass. A 70-mm infrarenal abdominal aortic aneurysm with severe proximal neck angulation and a 28-mm multilocular cystic tumor with mural nodules in the pancreas body were detected. Abdominal aortic repair with a prosthetic graft and distal pancreatectomy were performed simultaneously. The postoperative course was mostly uneventful, and he was discharged to a rehabilitation facility.

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Long-term outcomes and resource utilization of endovascular versus open repair of abdominal aortic aneurysms in Ontario

Cited by 29 publications

References 35 publications

Causes and Implications of Readmission After Abdominal Aortic Aneurysm Repair

Causes and Implications of Readmission After Abdominal Aortic Aneurysm Repair

Trends in abdominal aortic aneurysm repair in the era of endovascular technology in Ontario

A one-stage operation for abdominal aortic aneurysm and intraductal papillary mucinous neoplasms of the pancreas: report of a case

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