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OBJECTIVES - Endovascular treatment of splenic artery aneurysms (SAA) is increasingly common in clinical practice. The objective was to analyze the treatment and compare outcomes between endovascular and open surgery of this relatively rare diagnosis using national administrative data.
METHODS - We identified patients from the Nationwide Inpatient Sample (2003-2007) using ICD-9 codes for SAA as the primary or secondary diagnosis. These patient encounters were subdivided into endovascular treatment, open surgical treatment, or observation. Where appropriate, multivariable logistic and linear regression modeling were used to compare elective admission, type of payer, length of stay, total charges, and mortality.
RESULTS - In this representative sampling of non-federated hospital admissions, 684 patient encounters were identified resulting in a weighted estimate of 3,347 SAAs in the United States for the 5 year interval. Sixty-three percent were female, and the average age was 56.9 years. The overall mean length of stay was 5.99 days. The majority of patients were treated via open surgery (54%) when compared to endovascular means (26%). The remaining (20%) underwent in-hospital observation. In-hospital mortality after endovascular therapy was 4.2% and 6.0% after surgery (p=0.49). Non-elective admission was associated with higher mortality (adjusted odds ratio [AOR] 10.7, 95% confidence interval [CI] 3.3-34.6, p<0.001). Female gender (AOR 2.26, CI 1.56-3.27) and open surgery (AOR 0.62, CI 0.42-0.92) were independently associated with elective admission. Although elective treatment was more likely an open repair, a significantly shorter length of stay was associated with both elective admission (-3.6 days, p<0.001) and endovascular procedures independently (-3.7 days, p<0.001). Finally, when analyzed for total charges, elective and endovascular procedures were significantly less costly (p ≤ 0.001).
CONCLUSIONS - Elective treatment and endovascular repair of SAA result in a shorter length of stay and lower total charges . Given the comparable mortality outcomes for open and endovascular treatment, endovascular therapy may be preferable. As with all retrospective reviews, this issue deserves additional prospective study.