Outcomes and cost of fenestrated versus standard endovascular repair of intact abdominal aortic aneurysm in the United States

Satinderjit Locham, Muhammad Faateh, Jasninder Dhaliwal, Besma Nejim, Hanaa Dakour-Aridi, Mahmoud B. Malas

Research output: Contribution to journalArticle

Abstract

Background: Fenestrated endovascular aneurysm repair (FEVAR) has expanded the indications of this minimally invasive procedure to include patients with pararenal aneurysms. The actual cost of this relatively newer technology compared with standard endovascular aneurysm repair (EVAR) has not been studied before. Thus, the aim of this study was to analyze in-hospital costs and adverse outcomes in patients undergoing FEVAR vs EVAR for intact abdominal aortic aneurysms (AAAs). Methods: Using the Premier Healthcare Database (2012-2015), we identified all patients who underwent elective EVAR and FEVAR. Univariable (χ2 test, Student t-test, median test) and multivariable (logistic regression and generalized linear modeling) analyses were implemented to examine in-hospital cost and adverse outcomes adjusting for patients' demographics, comorbidities, and regional characteristics. Results: A total of 17,689 elective endovascular AAA repairs were performed; 1641 patients underwent FEVAR (9%), and the remaining 16,048 patients underwent standard EVAR (91%). Patients undergoing FEVAR were more likely to be white (86.3% vs 84.3%; P =.03). Both groups had similar comorbidities except for cerebrovascular disease, which was higher among patients undergoing FEVAR (8.4% vs 6.7%; P =.01). The total length of hospital stay was slightly higher in patients undergoing FEVAR compared with EVAR (mean [standard deviation], 2.40 [3.39] days vs 2.23 [3.10] days; P =.03). The rates of any complication (11.3% vs 9.6%), renal injury (5.8% vs 4.3%), and neurologic injury (0.7% vs 0.4%) were significantly higher in the FEVAR group (all P <.05). No differences were seen in mortality (0.8% vs 0.5%) or cardiac (4.9% vs 4.4%), pulmonary (2.4% vs 2.2%), and bowel (1.5% vs 1.2%) complications between the two groups (all P >.05). In multivariable logistic regression analysis, FEVAR was associated with 40% increased odds of renal failure (odds ratio, 1.40; 95% confidence interval [CI], 1.11-1.76; P =.004) and 91% increased odds of neurologic injury (odds ratio, 1.91; 95% CI, 1.02-3.57; P =.04). The median total cost of the treatment was also significantly higher among patients undergoing FEVAR ($28,227 vs $26,781; P <.001). After adjustment, generalized linear modeling analysis showed that the cost of FEVAR was on average $1612 higher than the cost of EVAR (adjusted cost, $1612; 95% CI, $1123-$2101; P <.001). Conclusions: In this large cohort of elective endovascular AAA repairs, compared with standard EVAR, FEVAR is associated with significantly increased odds of renal and neurologic injury. In addition, despite adjusting for patients' demographics, comorbidities, and major complications, total cost of FEVAR was significantly higher compared with standard EVAR. This is likely driven by the additional cost of fenestrated endografts and by the increased rate of complications related to FEVAR.

Original languageEnglish (US)
JournalJournal of Vascular Surgery
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Abdominal Aortic Aneurysm
Aneurysm
Costs and Cost Analysis
Nervous System Trauma
Comorbidity
Hospital Costs
Confidence Intervals
Length of Stay
Logistic Models
Odds Ratio
Demography
Kidney
Cerebrovascular Disorders

Keywords

  • AAA
  • Cost
  • Endovascular
  • Fenestrated
  • FEVAR
  • Outcomes

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Outcomes and cost of fenestrated versus standard endovascular repair of intact abdominal aortic aneurysm in the United States. / Locham, Satinderjit; Faateh, Muhammad; Dhaliwal, Jasninder; Nejim, Besma; Dakour-Aridi, Hanaa; Malas, Mahmoud B.

In: Journal of Vascular Surgery, 01.01.2018.

Research output: Contribution to journalArticle

Locham, Satinderjit ; Faateh, Muhammad ; Dhaliwal, Jasninder ; Nejim, Besma ; Dakour-Aridi, Hanaa ; Malas, Mahmoud B. / Outcomes and cost of fenestrated versus standard endovascular repair of intact abdominal aortic aneurysm in the United States. In: Journal of Vascular Surgery. 2018.
@article{33ee1cf71c384ff7b5fec20e860e77df,
title = "Outcomes and cost of fenestrated versus standard endovascular repair of intact abdominal aortic aneurysm in the United States",
abstract = "Background: Fenestrated endovascular aneurysm repair (FEVAR) has expanded the indications of this minimally invasive procedure to include patients with pararenal aneurysms. The actual cost of this relatively newer technology compared with standard endovascular aneurysm repair (EVAR) has not been studied before. Thus, the aim of this study was to analyze in-hospital costs and adverse outcomes in patients undergoing FEVAR vs EVAR for intact abdominal aortic aneurysms (AAAs). Methods: Using the Premier Healthcare Database (2012-2015), we identified all patients who underwent elective EVAR and FEVAR. Univariable (χ2 test, Student t-test, median test) and multivariable (logistic regression and generalized linear modeling) analyses were implemented to examine in-hospital cost and adverse outcomes adjusting for patients' demographics, comorbidities, and regional characteristics. Results: A total of 17,689 elective endovascular AAA repairs were performed; 1641 patients underwent FEVAR (9{\%}), and the remaining 16,048 patients underwent standard EVAR (91{\%}). Patients undergoing FEVAR were more likely to be white (86.3{\%} vs 84.3{\%}; P =.03). Both groups had similar comorbidities except for cerebrovascular disease, which was higher among patients undergoing FEVAR (8.4{\%} vs 6.7{\%}; P =.01). The total length of hospital stay was slightly higher in patients undergoing FEVAR compared with EVAR (mean [standard deviation], 2.40 [3.39] days vs 2.23 [3.10] days; P =.03). The rates of any complication (11.3{\%} vs 9.6{\%}), renal injury (5.8{\%} vs 4.3{\%}), and neurologic injury (0.7{\%} vs 0.4{\%}) were significantly higher in the FEVAR group (all P <.05). No differences were seen in mortality (0.8{\%} vs 0.5{\%}) or cardiac (4.9{\%} vs 4.4{\%}), pulmonary (2.4{\%} vs 2.2{\%}), and bowel (1.5{\%} vs 1.2{\%}) complications between the two groups (all P >.05). In multivariable logistic regression analysis, FEVAR was associated with 40{\%} increased odds of renal failure (odds ratio, 1.40; 95{\%} confidence interval [CI], 1.11-1.76; P =.004) and 91{\%} increased odds of neurologic injury (odds ratio, 1.91; 95{\%} CI, 1.02-3.57; P =.04). The median total cost of the treatment was also significantly higher among patients undergoing FEVAR ($28,227 vs $26,781; P <.001). After adjustment, generalized linear modeling analysis showed that the cost of FEVAR was on average $1612 higher than the cost of EVAR (adjusted cost, $1612; 95{\%} CI, $1123-$2101; P <.001). Conclusions: In this large cohort of elective endovascular AAA repairs, compared with standard EVAR, FEVAR is associated with significantly increased odds of renal and neurologic injury. In addition, despite adjusting for patients' demographics, comorbidities, and major complications, total cost of FEVAR was significantly higher compared with standard EVAR. This is likely driven by the additional cost of fenestrated endografts and by the increased rate of complications related to FEVAR.",
keywords = "AAA, Cost, Endovascular, Fenestrated, FEVAR, Outcomes",
author = "Satinderjit Locham and Muhammad Faateh and Jasninder Dhaliwal and Besma Nejim and Hanaa Dakour-Aridi and Malas, {Mahmoud B.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.jvs.2018.06.211",
language = "English (US)",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Outcomes and cost of fenestrated versus standard endovascular repair of intact abdominal aortic aneurysm in the United States

AU - Locham, Satinderjit

AU - Faateh, Muhammad

AU - Dhaliwal, Jasninder

AU - Nejim, Besma

AU - Dakour-Aridi, Hanaa

AU - Malas, Mahmoud B.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Fenestrated endovascular aneurysm repair (FEVAR) has expanded the indications of this minimally invasive procedure to include patients with pararenal aneurysms. The actual cost of this relatively newer technology compared with standard endovascular aneurysm repair (EVAR) has not been studied before. Thus, the aim of this study was to analyze in-hospital costs and adverse outcomes in patients undergoing FEVAR vs EVAR for intact abdominal aortic aneurysms (AAAs). Methods: Using the Premier Healthcare Database (2012-2015), we identified all patients who underwent elective EVAR and FEVAR. Univariable (χ2 test, Student t-test, median test) and multivariable (logistic regression and generalized linear modeling) analyses were implemented to examine in-hospital cost and adverse outcomes adjusting for patients' demographics, comorbidities, and regional characteristics. Results: A total of 17,689 elective endovascular AAA repairs were performed; 1641 patients underwent FEVAR (9%), and the remaining 16,048 patients underwent standard EVAR (91%). Patients undergoing FEVAR were more likely to be white (86.3% vs 84.3%; P =.03). Both groups had similar comorbidities except for cerebrovascular disease, which was higher among patients undergoing FEVAR (8.4% vs 6.7%; P =.01). The total length of hospital stay was slightly higher in patients undergoing FEVAR compared with EVAR (mean [standard deviation], 2.40 [3.39] days vs 2.23 [3.10] days; P =.03). The rates of any complication (11.3% vs 9.6%), renal injury (5.8% vs 4.3%), and neurologic injury (0.7% vs 0.4%) were significantly higher in the FEVAR group (all P <.05). No differences were seen in mortality (0.8% vs 0.5%) or cardiac (4.9% vs 4.4%), pulmonary (2.4% vs 2.2%), and bowel (1.5% vs 1.2%) complications between the two groups (all P >.05). In multivariable logistic regression analysis, FEVAR was associated with 40% increased odds of renal failure (odds ratio, 1.40; 95% confidence interval [CI], 1.11-1.76; P =.004) and 91% increased odds of neurologic injury (odds ratio, 1.91; 95% CI, 1.02-3.57; P =.04). The median total cost of the treatment was also significantly higher among patients undergoing FEVAR ($28,227 vs $26,781; P <.001). After adjustment, generalized linear modeling analysis showed that the cost of FEVAR was on average $1612 higher than the cost of EVAR (adjusted cost, $1612; 95% CI, $1123-$2101; P <.001). Conclusions: In this large cohort of elective endovascular AAA repairs, compared with standard EVAR, FEVAR is associated with significantly increased odds of renal and neurologic injury. In addition, despite adjusting for patients' demographics, comorbidities, and major complications, total cost of FEVAR was significantly higher compared with standard EVAR. This is likely driven by the additional cost of fenestrated endografts and by the increased rate of complications related to FEVAR.

AB - Background: Fenestrated endovascular aneurysm repair (FEVAR) has expanded the indications of this minimally invasive procedure to include patients with pararenal aneurysms. The actual cost of this relatively newer technology compared with standard endovascular aneurysm repair (EVAR) has not been studied before. Thus, the aim of this study was to analyze in-hospital costs and adverse outcomes in patients undergoing FEVAR vs EVAR for intact abdominal aortic aneurysms (AAAs). Methods: Using the Premier Healthcare Database (2012-2015), we identified all patients who underwent elective EVAR and FEVAR. Univariable (χ2 test, Student t-test, median test) and multivariable (logistic regression and generalized linear modeling) analyses were implemented to examine in-hospital cost and adverse outcomes adjusting for patients' demographics, comorbidities, and regional characteristics. Results: A total of 17,689 elective endovascular AAA repairs were performed; 1641 patients underwent FEVAR (9%), and the remaining 16,048 patients underwent standard EVAR (91%). Patients undergoing FEVAR were more likely to be white (86.3% vs 84.3%; P =.03). Both groups had similar comorbidities except for cerebrovascular disease, which was higher among patients undergoing FEVAR (8.4% vs 6.7%; P =.01). The total length of hospital stay was slightly higher in patients undergoing FEVAR compared with EVAR (mean [standard deviation], 2.40 [3.39] days vs 2.23 [3.10] days; P =.03). The rates of any complication (11.3% vs 9.6%), renal injury (5.8% vs 4.3%), and neurologic injury (0.7% vs 0.4%) were significantly higher in the FEVAR group (all P <.05). No differences were seen in mortality (0.8% vs 0.5%) or cardiac (4.9% vs 4.4%), pulmonary (2.4% vs 2.2%), and bowel (1.5% vs 1.2%) complications between the two groups (all P >.05). In multivariable logistic regression analysis, FEVAR was associated with 40% increased odds of renal failure (odds ratio, 1.40; 95% confidence interval [CI], 1.11-1.76; P =.004) and 91% increased odds of neurologic injury (odds ratio, 1.91; 95% CI, 1.02-3.57; P =.04). The median total cost of the treatment was also significantly higher among patients undergoing FEVAR ($28,227 vs $26,781; P <.001). After adjustment, generalized linear modeling analysis showed that the cost of FEVAR was on average $1612 higher than the cost of EVAR (adjusted cost, $1612; 95% CI, $1123-$2101; P <.001). Conclusions: In this large cohort of elective endovascular AAA repairs, compared with standard EVAR, FEVAR is associated with significantly increased odds of renal and neurologic injury. In addition, despite adjusting for patients' demographics, comorbidities, and major complications, total cost of FEVAR was significantly higher compared with standard EVAR. This is likely driven by the additional cost of fenestrated endografts and by the increased rate of complications related to FEVAR.

KW - AAA

KW - Cost

KW - Endovascular

KW - Fenestrated

KW - FEVAR

KW - Outcomes

UR - http://www.scopus.com/inward/record.url?scp=85054128830&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054128830&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2018.06.211

DO - 10.1016/j.jvs.2018.06.211

M3 - Article

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

ER -