Patient safety indicators give endo edge over open AAA repair

For abdominal aortic aneurysm (AAA), endovascular aneurysm repair (EVAR) is safer than open aneurism repair (OAR), according to a study published July 9 in JAMA Surgery. The study compared minimally invasive EVAR with the invasive OAR surgery using patient safety indicators.

This is the first study to use patient safety indicators to measure safety between minimally invasive and invasive procedures, according to authors John Rose, MD, MPH, of the University of California, San Diego, and colleagues.

Reviewing the difference between the newer EVAR and more traditional OAR procedure, researchers were looking to determine if safety was affected by the shifting preference in AAA repair procedure. The number of EVAR procedures steadily has increased between 2003 and 2010 while the number of OARs has decreased as more institutions adopt the EVAR technique and technologies improve to increase EVAR’s effectiveness and safety.

Rose et al reviewed data on 43,385 EVARs and 27,561 OARs available through a nationwide database. They found that EVAR procedures had a 3 percent and OARs had an 11.2 percent associated patient safety indicator rate.

Compared with OAR patients, patients who underwent the more minimally invasive procedure had a 72 percent reduction in mortality and a 42 percent reduction in avoidable post-operative complications. Rose et al noted that improving technologies over the seven-year period helped further reduce the likelihood of preventable complications in EVAR by 37 percent.

"Medical errors and patient safety are an ongoing concern with any new surgical innovation," said co-author David C. Chang, PhD, MPH, MBA, of the University of California, San Diego, in a press release. "This study shows the value in monitoring the safety of innovations. Patients need to keep this type of information in mind when considering different treatment options."

The number of EVAR procedures performed on AAAs has gone from 41.1 percent in 2003 to 75.3 percent in 2010. The only year EVAR failed to be statistically more successful than OAR was in 2007.

One question the research team was unable to answer was why there were some years EVAR seemed to have greater success than others. Lane et al suggested that this may have something to do with the development of EVAR-specific patient safety indicators that had not been in place previously. Once recognized, safety issues in these areas were then able to be addressed and rates again improved.

Lane et al recommended that further observation was necessary to identify and encourage continual improvements to procedural safety.