Spencer W Trooboff1,2,3, Zachary J Wanken4,3, Barbara Gladders3, Jesse A Columbo4,2, Jon D Lurie3, Philip P Goodney4,3. 1. Section of General Surgery (S.W.T.), Dartmouth-Hitchcock Medical Center, Lebanon, NH. 2. VA Quality Scholars Program, Veterans Health Association, White River Junction, VT (S.W.T., J.A.C.). 3. The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (S.W.T., Z.J.W., B.G., J.D.L., P.P.G.). 4. Section of Vascular Surgery (Z.J.W., J.A.C., P.P.G.), Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Abstract
BACKGROUND: Endovascular repair (EVR) has replaced open surgery as the procedure of choice for patients requiring elective abdominal aortic aneurysm (AAA) repair. Long-term outcomes of the 2 approaches are similar, making the relative cost of caring for these patients over time an important consideration. METHODS AND RESULTS: We linked Medicare claims to Vascular Quality Initiative registry data for patients undergoing elective EVR or open AAA repair from 2004 to 2015. The primary outcome was Medicare's cumulative disease-related spending, adjusted to 2015 dollars. Disease-related spending included the index operation and associated hospitalization, surveillance imaging, reinterventions (AAA-related and abdominal wall procedures), and all-cause admissions within 90 days. We compared the incidence of disease-related events and cumulative spending at 90 days and annually through 7 years of follow-up. The analytic cohort comprised 6804 EVR patients (median follow-up: 1.85 years; interquartile range: 0.82-3.22 years) and 1889 open repair patients (median follow-up: 2.62 years; interquartile range: 1.13-4.80 years). Spending on index surgery was significantly lower for EVR (median [interquartile range]: $25 924 [$22 280-$32 556] EVR versus $31 442 [$24 669-$40 419] open; P<0.001), driven by a lower rate of in-hospital complications (6.6% EVR versus 38.0% open; P<0.001). EVR patients underwent more surveillance imaging (1.8 studies per person-year EVR versus 0.7 studies per person-year open; P<0.001) and AAA-related reinterventions (4.0 per 100 person-years EVR versus 2.1 per 100 person-years open; P=0.041). Open repair patients had higher rates of 90-day readmission (12.9% EVR versus 17.8% open; P<0.001) and abdominal wall procedures (0.6 per 100 person-years EVR versus 1.5 per 100 person-years open; P<0.001). Overall, EVR patients incurred more disease-related spending in follow-up ($7355 EVR versus $2706 open through 5 years). There was no cumulative difference in disease-related spending between surgical groups by 5 years of follow-up (-$33 EVR [95% CI: -$1543 to $1476]). CONCLUSIONS: We observed no cumulative difference in disease-related spending on EVR and open repair patients 5 years after surgery. Generalized recommendations about which approach to offer elective AAA patients should not be based on relative cost.
BACKGROUND: Endovascular repair (EVR) has replaced open surgery as the procedure of choice for patients requiring elective abdominal aortic aneurysm (AAA) repair. Long-term outcomes of the 2 approaches are similar, making the relative cost of caring for these patients over time an important consideration. METHODS AND RESULTS: We linked Medicare claims to Vascular Quality Initiative registry data for patients undergoing elective EVR or open AAA repair from 2004 to 2015. The primary outcome was Medicare's cumulative disease-related spending, adjusted to 2015 dollars. Disease-related spending included the index operation and associated hospitalization, surveillance imaging, reinterventions (AAA-related and abdominal wall procedures), and all-cause admissions within 90 days. We compared the incidence of disease-related events and cumulative spending at 90 days and annually through 7 years of follow-up. The analytic cohort comprised 6804 EVR patients (median follow-up: 1.85 years; interquartile range: 0.82-3.22 years) and 1889 open repair patients (median follow-up: 2.62 years; interquartile range: 1.13-4.80 years). Spending on index surgery was significantly lower for EVR (median [interquartile range]: $25 924 [$22 280-$32 556] EVR versus $31 442 [$24 669-$40 419] open; P<0.001), driven by a lower rate of in-hospital complications (6.6% EVR versus 38.0% open; P<0.001). EVR patients underwent more surveillance imaging (1.8 studies per person-year EVR versus 0.7 studies per person-year open; P<0.001) and AAA-related reinterventions (4.0 per 100 person-years EVR versus 2.1 per 100 person-years open; P=0.041). Open repair patients had higher rates of 90-day readmission (12.9% EVR versus 17.8% open; P<0.001) and abdominal wall procedures (0.6 per 100 person-years EVR versus 1.5 per 100 person-years open; P<0.001). Overall, EVR patients incurred more disease-related spending in follow-up ($7355 EVR versus $2706 open through 5 years). There was no cumulative difference in disease-related spending between surgical groups by 5 years of follow-up (-$33 EVR [95% CI: -$1543 to $1476]). CONCLUSIONS: We observed no cumulative difference in disease-related spending on EVR and open repair patients 5 years after surgery. Generalized recommendations about which approach to offer elective AAA patients should not be based on relative cost.
Authors: Cornelis A van Bochove; Laura T Burgers; Anco C Vahl; Erwin Birnie; Marien G van Schothorst; William K Redekop Journal: J Vasc Surg Date: 2016-03 Impact factor: 4.268
Authors: Frank A Lederle; Tassos C Kyriakides; Kevin T Stroupe; Julie A Freischlag; Frank T Padberg; Jon S Matsumura; Zhiping Huo; Gary R Johnson Journal: N Engl J Med Date: 2019-05-30 Impact factor: 91.245
Authors: Monique Prinssen; Erik Buskens; Sjors E de Jong; Jacob Buth; Albert J Mackaay; Marc R van Sambeek; Marc R Sambeek; Jan D Blankensteijn Journal: J Vasc Surg Date: 2007-11 Impact factor: 4.268
Authors: Suniah Ayub; Salvatore T Scali; Julie Richter; Thomas S Huber; Adam W Beck; Javairiah Fatima; Scott A Berceli; Gilbert R Upchurch; Dean Arnaoutakis; Martin R Back; Kristina A Giles Journal: J Vasc Surg Date: 2018-06-21 Impact factor: 4.268
Authors: David H Stone; Alexander J Horvath; Philip P Goodney; Eva M Rzucidlo; Brian W Nolan; Daniel B Walsh; Robert M Zwolak; Richard J Powell Journal: J Vasc Surg Date: 2013-10-17 Impact factor: 4.268
Authors: Margaret A Olsen; Fang Tian; Anna E Wallace; Katelin B Nickel; David K Warren; Victoria J Fraser; Nandini Selvam; Barton H Hamilton Journal: Ann Surg Date: 2017-02 Impact factor: 12.969