Open Aortic Surgery in Endovascular Times: Challenges for Training and Hospital Systems

Endovascular aneurysm repair (EVAR) has surpassed the number of open repairs (OAR) in centers across country over last decade. Decreased opportunities for operative OAR training fellowship programs and potential more complicated anatomy may lead to worse patient outcomes. The purpose this study is compare outcomes from before (OAR1) after (OAR2) EVAR numbers within our institution. A retrospective review a single prospectively maintained vascular registry private surgeons who operated several hospitals including tertiary care academic hospital was queried any abdominal aortic surgery via or January 1997 December 2009. Data were stratified by years point equipoise where 2003. We also data order center surrounding community that we serve. group OAR1 2003 compared OAR2 using standard statistics. Demographics, indications, details, long-term results retrospectively reviewed analyzed. 1399 191 performed between 2002. 2019 there 859 1951 EVAR. Indications significantly different with ruptures (170; 19.8% vs 169, 12.1% P value <00001). Demographics similar groups, however comorbidities trended severe OAR2. Aneurysm size, estimated blood loss, renal interventions groups. Ruptured mortality rates higher (76; 44.7% 21, 12.4% < .00001) had non-ruptured (44; 6.4% 7, 0.5% .00001). Subset analysis based on versus demonstrated much ruptured proliferation decreased subsequently selected anatomy. Consequently, have regressed prompt change systems.TableComparison outcomesAlbany Medical Center MortalityCommunity Hospitals MortalityP valueOAR 1 Elective AAA Repair.74%.22%.2456OAR 2 Repair5.6%6.04%.8201OAR Repair5.67%11.95%.0623OAR Repair25.6%40.74%.0086OAR 1: Pre-endovascular era defined as prior 2003.OAR 2: Post-endovascular Open table new tab