Journal article
Improving aneurysm-related outcomes: Nationwide benefits of endovascular repair
Journal of vascular surgery, v 43(3), pp 446-452
01 Mar 2006
PMID: 16520153
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Endovascular aneurysm repair (EVAR) has changed the practice of abdominal aortic aneurysm (AAA) surgery. We examined a national Medicare database to establish the effect of EVAR introduction into the United States.
A 5% random sample of inpatient Medicare claims from 2000 to 2003 was queried using International Classification of Diseases, 9th Revision (ICD-9) diagnosis and procedure codes. An EVAR procedure code was available after October 2000. Occurrences were multiplied by 20 to estimate yearly national volumes and then divided into the yearly Centers for Medicare and Medicaid Services (CMS) population of elderly Medicare recipients for rates per capita, reported as cases per 100,000 elderly Medicare recipients. Statistical analysis was performed by using χ
2, Student’s t test, nonparametric tests, and multiple regression analysis, with significance defined as
P ≤ .05.
Elective AAA repairs averaged 87.7 per 100,000 Medicare patients between 2000 and 2003, with EVAR has steadily increasing to 41% of elective repairs in 2003. From 2000 to 2003, overall elective AAA mortality declined from 5.0% to 3.7% (
P < .001), while open repair mortality remained unchanged. EVAR patients are significantly older than patients treated with open repair. From 2000 to 2003 patients >84 years receiving EVAR increased to 62.7% (
P < .001). Overall hospital length of stay (LOS) decreased from 8.6 days in 2000 to 7.3 days in 2003,
P < .001, but increased for open AAA patients. EVAR patients were more likely to be discharged home rather than to skilled facilities. Average elective repair hospital charges were not different between groups, but Medicare reimbursement was lower for EVAR, with a higher proportion cases classified as DRG 111 (major cardiovascular procedure without complications). EVAR was used in 10.6% of ruptured AAA repairs in 2003, with a significant reduction in mortality compared with open repairs for rupture (31.8% vs 50.8%;
P < .001).
EVAR is replacing open surgery without an increase in overall case volume. EVAR is responsible for overall decrease in operative mortality even in ruptured aneurysms while decreasing utilization variables. Reimbursement to hospitals is shrinking, however.
Metrics
Details
- Title
- Improving aneurysm-related outcomes: Nationwide benefits of endovascular repair
- Creators
- Ellen D. Dillavou - University of PittsburghSatish C. Muluk - Allegheny General HospitalMichel S. Makaroun - University of Pittsburgh
- Publication Details
- Journal of vascular surgery, v 43(3), pp 446-452
- Publisher
- Mosby, Inc
- Number of pages
- 7
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Cardiothoracic Surgery
- Web of Science ID
- WOS:000235848800003
- Scopus ID
- 2-s2.0-33644693385
- Other Identifier
- 991021944484304721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Peripheral Vascular Disease
- Surgery