{"doi":"10.1161/circoutcomes.119.006249","title":"Longitudinal Spending on Endovascular and Open Abdominal Aortic Aneurysm Repair","abstract":"Background: Endovascular repair (EVR) has replaced open surgery as the procedure of choice for patients requiring elective abdominal aortic aneurysm (AAA) repair. Long-term outcomes of the 2 approaches are similar, making the relative cost of caring for these patients over time an important consideration. Methods and Results: We linked Medicare claims to Vascular Quality Initiative registry data for patients undergoing elective EVR or open AAA repair from 2004 to 2015. The primary outcome was Medicare’s cumulative disease-related spending, adjusted to 2015 dollars. Disease-related spending included the index operation and associated hospitalization, surveillance imaging, reinterventions (AAA-related and abdominal wall procedures), and all-cause admissions within 90 days. We compared the incidence of disease-related events and cumulative spending at 90 days and annually through 7 years of follow-up. The analytic cohort comprised 6804 EVR patients (median follow-up: 1.85 years; interquartile range: 0.82–3.22 years) and 1889 open repair patients (median follow-up: 2.62 years; interquartile range: 1.13–4.80 years). Spending on index surgery was significantly lower for EVR (median [interquartile range]: $25 924 [$22 280–$32 556] EVR versus $31 442 [$24 669–$40 419] open; P <0.001), driven by a lower rate of in-hospital complications (6.6% EVR versus 38.0% open; P <0.001). EVR patients underwent more surveillance imaging (1.8 studies per person-year EVR versus 0.7 studies per person-year open; P <0.001) and AAA-related reinterventions (4.0 per 100 person-years EVR versus 2.1 per 100 person-years open; P =0.041). Open repair patients had higher rates of 90-day readmission (12.9% EVR versus 17.8% open; P <0.001) and abdominal wall procedures (0.6 per 100 person-years EVR versus 1.5 per 100 person-years open; P <0.001). Overall, EVR patients incurred more disease-related spending in follow-up ($7355 EVR versus $2706 open through 5 years). There was no cumulative difference in disease-related spending between surgical groups by 5 years of follow-up (−$33 EVR [95% CI: −$1543 to $1476]). Conclusions: We observed no cumulative difference in disease-related spending on EVR and open repair patients 5 years after surgery. Generalized recommendations about which approach to offer elective AAA patients should not be based on relative cost.","journal":"Circulation Cardiovascular Quality and Outcomes","year":2020,"id":72871,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":14,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.7535,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":384481,"name":"Zachary J. Wanken","orcid":null,"position":1,"is_corresponding":false},{"id":383684,"name":"Barbara Gladders","orcid":"0000-0003-0790-7265","position":2,"is_corresponding":false},{"id":383685,"name":"Jesse A. Columbo","orcid":"0000-0003-3225-4403","position":3,"is_corresponding":false},{"id":302628,"name":"Jon D. Lurie","orcid":"0000-0001-5672-7725","position":4,"is_corresponding":false},{"id":383686,"name":"Philip P. Goodney","orcid":"0000-0002-3973-3506","position":5,"is_corresponding":false},{"id":383683,"name":"Spencer W. Trooboff","orcid":"0000-0002-8138-889X","position":0,"is_corresponding":true}],"reference_count":27,"raw_metadata":null,"created_at":"2026-07-18T21:45:09.279825Z","pmid":"32375504","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}