Factors that affect cost and clinical outcome of endovascular aortic repair for abdominal aortic aneurysm

• Published in: Journal of vascular surgery 2017-04, Vol.65 (4), p.997-1005
• Main Authors: O'Brien-Irr, Monica S., MS, RN, Harris, Linda M., MD, Dosluoglu, Hasan H., MD, Cherr, Gregory S., MD, Rivero, Mariel, MD, Noor, Sonya, MD, Curl, G. Richard, MD, Dryjski, Maciej L., MD, PhD
• Format: Article
• Language: English
• Subjects: Academic Medical Centers - economics; Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - economics; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - surgery; Blood Vessel Prosthesis - economics; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - economics; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - mortality; Chi-Square Distribution; Cost Savings; Cost-Benefit Analysis; Disease-Free Survival; Endovascular Procedures - adverse effects; Endovascular Procedures - economics; Endovascular Procedures - instrumentation; Endovascular Procedures - mortality; Female; Hospital Costs; Humans; Kaplan-Meier Estimate; Male; Middle Aged; New York; Postoperative Complications - economics; Postoperative Complications - etiology; Postoperative Complications - therapy; Prosthesis Design; Retreatment - economics; Retrospective Studies; Risk Factors; Surgery; Time Factors; Treatment Outcome
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2016.08.090

Abstract Objective This study evaluated the effect of indication for use (IFU), additional graft components, and percutaneous closure of endovascular aortic repair (PEVAR) on clinical outcomes and cost of endovascular aortic repair (EVAR). Methods Clinical and financial data were obtained for all elective EVARs completed at a university-affiliated medical center between January 2012 and June 2013. Data were analyzed by χ2 , Student t -test for independent samples, and Kaplan-Meier survival. Results There were 67 elective EVARs. Additional cuffs/extensions were used in 37%, increasing the baseline graft cost by 36% ( P  < .001), total costs by 20% ( P  < .001), and negatively affecting the contribution margin. Aortic neck IFU ( P  = .02), failure of the index graft to seal the neck ( P  = .02), and need for an additional cuff ( P  = .008) were related to the need for reintervention for type Ia endoleak for graft B (Excluder; W. L. Gore and Associates, Flagstaff, Ariz), whereas limb IFU was related to the need for additional limb extension for graft A (Powerlink; Endologix, Irvine, Calif; P  < .001). Limb extension ( P  = .06) and failure of the index graft to provide an adequate seal ( P  < .001) were associated with reintervention for type Ib endoleak. Reintervention-free rates at 24 months were 96% for graft A and 94% for graft B ( P  =.54), but different patterns in reintervention emerged: graft A required reoperation early (