Propensity score analysis demonstrates no long term survival benefit from contemporary endovascular aneurysm repair compared to open in Aotearoa New Zealand

Abstract

BackgroundCurrent guidelines for AAA management are based on landmark trials comparing EVAR and open aneurysm repair (OAR) conducted more than 20 years ago. Important advancements have been made in peri‐operative care but the impact of EVAR and OAR on long‐term patient survival has not been well reported using contemporary data. The objective of this study was to compare the short and long‐term outcomes of OAR and EVAR in the recent era.MethodsThis retrospective observational study included all patients undergoing intact AAA repair in NZ from 1st of January 2011 until 31st of December 2019. Data was collected from national administrative and clinical vascular databases and matched using unique identifiers. Time‐to‐event survival analyses was conducted using cox proportional hazard models to adjust for confounders and propensity score matching were used.ResultsTwo thousand two hundred and ninety‐seven patients had an intact AAA repair with a median (IQR) age of 75 (69–80) years; 494 (21.2%) patients were females and 1206 (53%) underwent EVAR. The 30‐day mortality for OAR and EVAR was 4.8% and 1.2%. The median (IQR) follow up was 5.2 (2.3–9.2) years. After propensity matching for co‐variates, the study cohort consisted of 835 patients in each matched group. Patients undergoing EVAR had a higher overall mortality (HR 1.48 (95% CI: 1.26–1.74) after adjusting for confounders compared to OAR.ConclusionAnalysis of survival following EVAR and OAR in the current era demonstrates that patients that underwent EVAR had a lower 30‐day mortality. However, in the long‐term after adjusting for confounders OAR had a better overall survival.