Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm Results in Higher Hospital Expenses than Open Surgical Repair: Evidence from a Tertiary Hospital in Brazil

Ann Vasc Surg. 2016 Oct;36:44-54. doi: 10.1016/j.avsg.2016.03.016. Epub 2016 Jul 13.


Background: Endovascular aneurysm repair (EVAR) has become the preferred approach for the treatment of infrarenal abdominal aortic aneurysm (IRAAA) in detriment of open surgical repair (OSR). EVAR results in lower mortality rates within 30 days, but rates tend to be the same after longer periods. Moreover, reduced use of hospital resources with EVAR does not necessarily offset the costs of the endoprosthesis. We aimed, in this study, to estimate hospital expenses after OSR or EVAR, including early and late readmissions.

Methods: Retrospective analysis of hospital expenses (2005-2012) with elective IRAAA surgeries performed in a tertiary hospital, including 127 patients divided into 2 groups, EVAR (n = 102) and OSR (n = 25).

Results: One perioperative death occurred in each group. EVAR interventions lasted 145 vs. 210 min of OSR (P < 0.001). Among OSR patients, 68% required packed red blood cells. Among EVAR patients, this proportion was 7.8% (P < 0.001). Median hospitalization time differed significantly for EVAR (4 days) and OSR (8 days; P < 0.001, intervals EVAR: 1-17 days, OSR: 2-442 days). The median and mean expenses with EVAR were US $53,080.95 and US $56,289.49, respectively. The median and mean expenses with OSR were US $37,116.04 and US $68,788.54, respectively. Early readmissions reached 11.2%. None of the OSR patients required late reinterventions, but 10 (9.9%) EVAR patients did, one of whom died.

Conclusions: EVAR resulted in higher expenses with the exclusion of one outlier. Late reinterventions, with elevated costs, were only required by EVAR patients. Thus, when patients are eligible to undergo either intervention, OSR seems to have lower costs and better long-term results.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Aortic Aneurysm, Abdominal / economics*
  • Aortic Aneurysm, Abdominal / mortality
  • Aortic Aneurysm, Abdominal / surgery*
  • Blood Vessel Prosthesis / economics
  • Blood Vessel Prosthesis Implantation / adverse effects
  • Blood Vessel Prosthesis Implantation / economics*
  • Blood Vessel Prosthesis Implantation / instrumentation
  • Blood Vessel Prosthesis Implantation / mortality
  • Brazil
  • Cost Savings
  • Cost-Benefit Analysis
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / economics*
  • Endovascular Procedures / instrumentation
  • Endovascular Procedures / mortality
  • Female
  • Hospital Costs*
  • Humans
  • Length of Stay / economics
  • Middle Aged
  • Patient Readmission / economics
  • Postoperative Complications / mortality
  • Postoperative Complications / therapy
  • Retrospective Studies
  • Stents / economics
  • Tertiary Care Centers / economics*
  • Time Factors
  • Treatment Outcome