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Changes in Abdominal Aortic Aneurysm Rupture and Short Term Mortality 1995-2008
Marc L Schermerhorn*1, Rodney P Bensley, Jr.*1, Kristina A Giles*1, Rob Hurks*1, A J O'Malley*2, Philip Cotterill*3, Elliot Chaikof1, Bruce E Landon*1
1Beth Israel Deaconess Medical Center, Boston, MA;2Department of Health Care Policy, Harvard Medical School, Boston, MA;3Centers for Medicare and Medicaid Services, Baltimore, MD

OBJECTIVE(S): Prior studies demonstrated stable rates of AAA repair, repair mortality, and AAA rupture. Recently, EVAR has been introduced and has expanded to over 75% of elective AAA repairs.
METHODS: We identified Medicare beneficiaries undergoing AAA repair and those hospitalized with AAA rupture during 1995-2008 and calculated standardized annual rates of short-term AAA-related deaths due to elective repair or rupture.
RESULTS: 338,278 patients underwent intact AAA repair. 69,653 patients presented with rupture of whom 47,524 underwent repair. Intact repair rates increased substantially in those over age 80 (57.7 to 92.3 per 100,000, P<0.001), but decreased in those aged 65-74 (81.8 to 68.9, P<0.001). By 2008, 77% of intact repairs and 31% of rupture repairs were EVAR (P<0.001). Operative mortality declined over time for both intact (4.9% to 2.4%, P<0.001) and ruptured (44.1% to 36.3%, P<0.001) AAA repair. A decline in ruptures was seen in all age groups. Short-term AAA-related deaths decreased by more than half (26.1 to 12.1 per 100,000, P<0.001) with the greatest decline occurring in those over age 80 (53.7 to 27.3, P<0.001).
CONCLUSIONS: A recent decline in AAA rupture and short-term AAA-related mortality is demonstrated and likely related in part to the introduction and expansion of EVAR. This is due to decreased deaths from ruptures (with and without repair) and decreased mortality with intact repairs, particularly in patients over age 80.

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