40.09 NATIONAL TRENDS IN THE MANAGEMENT OF RUPTURED AAA

Posted on September 9, 2020

A. Haider1, A. Safaya1, S. Babu1, R. Mateo1, A. Goyal1, F. Carroll1, I. Laskowski1  1New York Medical College,Surgery,Valhalla, NY, USA

Introduction:
Ruptured abdominal aortic aneurysm (AAA) remains a deadly condition with a high mortality and morbidity. Endovascular aneurysm repair (EVAR) has gained wide acceptance in the management of elective AAA and is now being increasingly utilized in the treatment of ruptured AAA (RAAA) over open repair when feasible. Current studies do not conclusively deem one approach superior over the other. The aim of our study was to assess the national trends in the diagnosis, management, and outcomes of RAAA over the last decade.

Methods:
We performed a 12 year (2004-2015) analysis of the National Inpatient Sample database. Patients with a diagnosis of ruptured abdominal aortic aneurysm were identified who underwent an open AAA repair or EVAR. Outcomes measures were overall rate of operative repair for RAAA, EVAR and open AAA repair rates, mortality, and hospital length of stay. Trend analysis was performed.

Results:
A total of 14,660 patients were admitted with ruptured AAA during the study period of which 59.4% (n=8712) were managed operatively with open repair or EVAR. Mean age was 75.1±10.4 years, 71.2% were male, and mean Charlson Comorbidity Index was 1.48±1.52. During that period overall more patients underwent surgical repair of RAAA with an increase from 56.8% to 61.5% (p<0.001). In that cohort the rate of EVAR for RAAA also increased from 13.3% in 2004 to 58.9% in 2015 (p<0.001) and there was a corresponding decrease in the rate of open AAA repair from 86.7% in 2004 to 41.1% in 2015 (p<0.001). There was a significant decrease in the overall mortality (49.3% in 2004 vs. 37.5% in 2015; p<0.001) as well as surgical mortality associated with RAAA (38.0% in 2004 vs. 26.4% in 2015; p<0.001). Overall, there was an associated decrease in the mean hospital length of stay for RAAA from 10.6±14.2 days in 2004 to 8.0±10.6 days in 2015 (p<0.001).

Conclusion:
The overall rate of operative repair for RAAA has increased modestly. There has been a major paradigm shift in the management of RAAA with more than 4 times increase in the rate of EVAR and a corresponding decrease in the rate of open repair over the last decade. This change in management has been associated with a significant improvement in the morbidity and mortality after RAAA.