Background: Endovascular abdominal aortic aneurysm repair (EVAR), when compared to conventional open surgical repair, has been shown to reduce perioperative morbidity and mortality. A retrospective cohort study was performed with data from the Department of Veterans Affairs to examine outcomes in routine daily practice following EVAR and open surgical repair. Methods: In this study, I examined 30-day mortality, 1-year survival, and postoperative complications in 1957 patients who underwent elective AAA repair (EVAR n=717 (36.6%); open n=l240 (63.4%)) at 123 VA hospitals between May 1, 2001 and September 30, 2003. Also, this review investigated the influence of patient, operative, and hospital variables on outcome, and used propensity scoring to adjust for the nonrandom allocation of patients to either EVAR or open procedures. Results: Patients undergoing EVAR had significantly lower 30 day (3.1% vs. 5.7%, p=0.0079) and 1 year mortality (8.4% vs. 12.0%, p=0.0121) than patients having open repair. EVAR was positively and independently associated with a decrease in 30-day postoperative mortality (adjusted OR=0.58; 95% CI=0.35, 0.97; p=0.0367). The risk of any perioperative complication was much less following EVAR (4.5% vs. 14.2%; p<0.0001; unadjusted OR 0.48; 95% CI =0.37, 0.63; p<0.001). Patients operated on at low volume hospitals (25% of entire cohort) were more likely to have had open repair (31.6% compared to 15.9% EVAR; p <0.001) as well as a two-fold increased adjusted 30-day mortality risk (OR=2.06; 95% CI=1.32, 3.26; p=0.0015). Conclusions: In routine daily practice, patients presenting for elective AAA repair who undergo EVAR have substantially lower perioperative mortality and morbidity rates compared to patients having open repair. The benefits of a minimally invasive approach were readily apparent in this cohort; however, caution should be exercised in choosing EVAR for all elective AAA repairs until longer-term data on device durability are available. Furthermore, widely available screening programs may aid in the early detection of AAA, which would further facilitate timely surgical intervention and, ultimately, improve outcomes.Master of Public Healt
