Le ST, Prentice HA, Harris JE, Hsu JH, Rehring TF, Nelken NA, Hajarizadeh H, Chang RW. Decreasing Trends in Reintervention and Readmission After Endovascular Aneurysm Repair in a Multiregional Implant Registry.
J Vasc Surg 2022;
76:1511-1519. [PMID:
35709865 DOI:
10.1016/j.jvs.2022.04.054]
[Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/12/2022] [Accepted: 04/24/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES
As endovascular aortic aneurysm repair (EVAR) matures into its third decade, measures such as long-term reintervention and readmission have become a focus of quality improvement efforts. Within a large United States integrated healthcare system, we describe time trends in the rates of long-term reinterventions utilization measures.
METHODS
Data from a US multiregional EVAR registry was used to perform a descriptive study of 3,891 adults who underwent conventional infrarenal EVAR for infrarenal abdominal aortic aneurysm between 2010 to 2019. Three-year follow-up was 96.7%. Outcomes included 1-, 3-, and 5-year graft revision (defined as a procedure involving placement of a new endograft component), secondary interventions (defined as a procedure necessary for maintenance of EVAR integrity, e.g., coil embolization and balloon angioplasty/stenting), conversion to open, interventions for type II endoleaks alone, and 90-day readmission. Crude cause-specific reintervention probabilities were calculated by operative year using the Aalen-Johansen estimator, with death as a competing risk and December 31, 2020 as the study end date.
RESULTS
Excluding interventions for type II endoleak alone, 1-year secondary intervention incidence decreased from 5.9% for EVARs in 2010 to 2.0% in 2019 (p<0.001) and 3-year incidence decreased from 7.2% to 3.6% from 2010 to 2017 (p=0.03). The 3-year incidences of graft revision (mean incidence 3.4%) and conversion to open remained fairly stable (mean incidence 0.6%) over time. The 3-year incidence of interventions for type II endoleak alone also decreased from 3.4% in 2010 to 0.7% in 2017 (p=0.01). 90-day readmission rates decreased from 19.3% for index EVAR in 2010 to 9.2% in 2019 (p=0.03).
CONCLUSIONS
Comprehensive data from a multiregional healthcare system demonstrates decreasing long-term secondary intervention and readmission rates over time in patients undergoing EVAR. These trends are not explained by evolving management of type II endoleaks and suggest improving graft durability, patient selection or surgical technique. Further study is needed to define implant and anatomic predictors of different types of long-term reintervention.
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