Introduction: Open abdominal aortic aneurysm (AAA) repair is a complex procedure requiring specific training. Prior to the development of the certification in vascular surgery by the American Board of Surgery (ABS) in 1982, the majority of these procedures were performed by general surgeons. The purpose of this study was to compare outcomes of open abdominal aortic aneurysm repair between surgeons with ABS certification in vascular surgery and those with certification solely in general surgery.
Methods: Medical claims data were obtained from the Center for Medicare and Medicaid Services (CMS), including final billing records from inpatient claims from 2020. Procedures were identified by the primary ICD 10 procedure code. Claims data were aggregated by operating physician and the proportion of physicians who performed at least one of the study procedures was reported for each group. Logistic regression models were used to model the likelihood of inpatient death and post-operative complications. Models included admission type, age, sex, race, operating physician taxonomy, and metropolitan status as risk factors. Results are reported as odds ratios and 95% confidence intervals.
Results: There were 10,527 cases of AAA repair identified. Open repair made up 1,801 of these cases; of which the majority (65%) were elective. Overall, 183 patients died (10.2 %), and 813 (45.1 %) had a post-operative complication. The greatest risk factor for inpatient mortality for open AAA procedures was non-elective status (OR 4.47 (3.18,6.27)) and age over 85 (OR 4.43 (2.25,8.73)). In elective procedures, the greatest risk factor for mortality was age 85 and older (OR 6.58 (1.84-23.56)). Patients residing in a non-metropolitan area had a greater risk of mortality (OR 1.91 (1.1,3.31) in elective cases. Procedures performed by general surgeons had a greater risk of mortality when compared to vascular surgeons in all cases (OR 1.87 (1.21,2.88)) and when limiting to elective cases (OR 2.12 (1.12,4.02)). Regarding post-operative complications, the greatest risk was non-elective status (OR 2.1 (1.72,2.57)).
Conclusion: Open repair of abdominal AAA is a complex procedure with significant mortality. Compared to vascular surgeons, general surgeons had higher mortality with open AAA repair in both elective and emergent settings. Training and ABS certification in vascular surgery are essential to reduce this risk.
