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Monday, April 26, 2021

Outpatient Percutaneous Endovascular Abdominal Aortic Aneurysm Repair: A Single-Center Experience

Outpatient Percutaneous Endovascular Abdominal Aortic Aneurysm Repair: A Single-Center Experience


Clinical Question

Evaluate the safety of outpatient percutaneous endovascular abdominal aortic repair (PEVAR) when compared to inpatient PEVAR.

Take away point
Outpatient PEVARs are a safe option with decreased procedure time.

Reference:
Lo, Tzu-Chin, et al. “Outpatient Percutaneous Endovascular Abdominal Aortic Aneurysm Repair: A Single-Center Experience.” Journal of Vascular and Interventional Radiology, vol. 32, no. 3, 2021, pp. 466–471., doi:10.1016/j.jvir.2020.11.012.

Click here for abstract

Study design
Retrospective review of all elective outpatient or inpatient PEVARs for infrarenal AAA repair between January 2012 and June 2019.

Funding Source
No reported funding.

Setting
Academic setting, Chang Gung Memorial Hospital, Taoyuan, Taiwan

Figure



Summary


Percutaneous endovascular aortic repair (PEVAR) is an alternative to open femoral exposure with a reduction in procedure times and complication rates. This study seeks to evaluate the safety of outpatient based PEVAR when compared to PEVAR. This retrospective review of PEVARs performed over a 7-year span evaluated inpatient and outpatient PEVARs among 359 patients.

Patients who had asymptomatic AAA with an aneurysm sac diameter greater than 5 cm with anatomy compatible with standard off-the-shelf devices and with an available caregiver at home were selected for the outpatient group. All outpatients and most inpatients received total intravenous anesthesia (TIVA) with propofol and fentanyl, an important factor in reducing complications.

The Society of Interventional Radiology’s classification system was used to grade complications. The primary outcome measure included mortality, complications, length of stay, and readmissions. No outpatient mortalities were documented and 4 inpatient mortalities occurred. There were no statistically significant differences in complications between the two groups. No statistically significant difference in length of stay among outpatients that were admitted unexpectedly and inpatients.

The secondary outcome was operative time. Mean operative times only for outpatients were significantly shorter, 150 minutes +/- 32 vs 172 minutes +/- 53 (P < 0.01), without inclusion of any adjunct procedures. When adjunct procedures were required, no statistically significant difference was observed between the outpatient and inpatient groups.

Commentary


As healthcare costs continue to be an important issue in the United States, outpatient treatment allows an avenue to reduce costs. The authors of this paper noted, the single-payer system in Taiwan significantly reduces costs for patients with or without admission. In contrast, outpatient treatment could result in significant cost reduction in the United States. Limitations of this study include a small sample size and number of adverse outcomes, which may not effectively capture the risks associated with outpatient and inpatient treatment. Another limitation of this study is that patients are pre-screened, thus complication rates are inherently lower among the outpatient group. This study also did not evaluate the costs associated with inpatient versus outpatient treatment including those associated with readmission, which can be a major driving force toward the adoption of outpatient treatment. Finally, an important consideration is the patient’s willingness to elect for outpatient aortic repair. The consideration of outpatient PEVARs and the use of total intravenous anesthesia can have significant impacts on healthcare costs in the United States and this is a topic that warrants further investigation.

Post Author
Waqaar Diwan, MD
PGY-3 Diagnostic Radiology Residency
Baylor University Medical Center
Waqaar.diwan@bswhealth.org

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