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Resource Utilization of Open vs Endovascular Repair of Complex Abdominal Aortic Anerysms
Derek P. de Grijs, MD, William Z. Chancellor, MD, Ian C. Armstrong, MS, Benjamin N. Contrella, MD, Carlin A. Williams, MD, John F. Angle, MD, Luke R. Wilkins, MD, William P. Robinson, MD, John A. Kern, MD, Gilbert R. Upchurch, MD, Kenneth J. Cherry, MD, Robert B. Hawkins, MD, Megan C. Tracci, MD JD.
University of Virginia, Charlottesville, VA, USA.

Objective: Innovations in aortic endovascular surgery are allowing for increasingly more complex aneurysms to be repaired in an endovascular fashion. As we continue to test the limits of these repairs, we must give careful thought to their economic impact. The aim of this study is to evaluate the efficacy and cost of patients undergoing open and endovascular repair of complex aortic aneurysms.
Methods: Patients who underwent open surgical or endovascular repair of a pararenal or paravisceral abdominal aortic aneurysm at a single institution between 2011 and 2017 were identified in an institutional clinical data repository. Demographic, operative, and surgical outcomes data were obtained by chart review and paired with institutional financial records. The primary outcomes of interest were resource utilization including cost of index hospitalization and total attributable costs incurred within the first post-operative year.
Results: A total 109 patients were identified for inclusion, including 58 open and 51 endovascular repairs. Baseline demographics of the two groups were similar, as were measured clinical outcomes and survival within the study period. In terms of resource utilization, more patients in the open cohort required blood transfusions (66% vs 41%, p=.01) but fewer reoperations (12.1% vs 29.4%, p=.02). The median length of stay was significantly longer in the open repair cohort (10.8 vs 8.6 days, p=.0008). The in-hospital cost was significantly lower for open repair group ($52,094 $36,026 versus $83,853 $70,822, p=.0006). This difference was driven by supply costs, including endografts, ($5,180 3,552 versus $35,192 17,144, p<.0001). Meanwhile, open surgery patients had higher ICU cost ($21,864 18,334 versus $17,881 24,934, p=.04). Postoperative costs attributable to aneurysm repair in the first year were $2,321 less in the open cohort ($9,967 36,026 versus $12,288 22,243, p=.004).
Conclusion: Complex abdominal aortic aneurysms require high resource utilization perioperatively, with endovascular repair having $30,000 higher cost. This disparity is created in large part by endograft costs, which is only minimally mitigated by shorter ICU stay in the endovascular group. The higher cost of endovascular repair persisted during the first year postoperatively. In a progressively more cost conscious healthcare climate, these findings should be considered when deciding upon the ideal treatment strategies for patients with complex aortic aneurysms.


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