Long-Term Changes in AAA Treatment Evaluated in Medicare Patient Population
June 5, 2018—In Journal of Vascular Surgery (JVS), Bjoern D. Suckow, MD, et al, published findings from an evaluation of national trends in open surgical repair, endovascular aneurysm repair (EVAR), and branched-fenestrated EVAR of abdominal aortic aneurysms (AAAs) in Medicare beneficiaries from 2003 to 2013 (2018;67:1690–1697). Using Medicare Part B claims to ascertain counts of these repair types annually during the study period, the investigators assessed regional and national trends in characteristics of the patients and procedure volume.
The study showed that the number of open AAA repairs declined by approximately 80% during the last decade, traditional EVAR slightly declined, and branched-fenestrated EVAR rapidly disseminated into national practice.
The investigators concluded that the findings suggest that open AAA repair is now performed too infrequently to be used as a metric in the assessment of hospital and surgeon quality in cardiovascular care. They advised that surgical training paradigms will need to reflect the changing dynamics to ensure that surgeons and interventionists can safely perform these high-risk surgical procedures.
As summarized in JVS, the total number of AAA repairs performed in fee-for-service Medicare patients declined by 26% from 31,582 in 2003 to 23,421 in 2013 (P < .001). A peak number of 32,540 repairs were performed in 2005 (28% decline since 2005). The number of open AAA repairs steadily declined by a total of 76%, from 20,533 in 2003 to 4,916 in 2013 (P < .001).
The analysis also found that the number of EVARs increased from 11,049 in 2003 to 19,247 in 2011 (P < .001), but it has since declined a total of 15% to only 16,362 repairs in 2013 (P < .001).
After its introduction in 2011, the number of branched-fenestrated EVAR cases continuously rose from 335 procedures in 2011 to 2,143 procedures in 2013 (P < .001). By 2013, virtually all hospital referral regions in the United States had rates of open AAA repair that would have been in the lowest quintile of volume in 2003, reported the investigators in JVS.