The Impact of Introducing a Surgeon-Led Emergency EVAR Service on Outcomes and Cost Efficiency in Ruptured Aortic Aneurysm Management: A UK Single-Center Experience

Abstract

Objective

To evaluate the impact of introducing a surgeon-led emergency endovascular aneurysm repair (EVAR) service on patient outcomes and cost efficiency in the management of ruptured abdominal aortic aneurysms (rAAA) at a UK tertiary vascular center.

Methods

A retrospective cohort study was conducted, including all patients presenting with rAAA between January 2019 and December 2023. Patients were categorized into two time periods: before (Period A: 2019-2020) and after (Period B: 2021-2023) the introduction of the emergency EVAR service. Outcomes assessed included 30-day and one-year mortality, length of hospital stay, complication rates, and return-to-theatre rates. Cost-effectiveness analysis was conducted using incremental cost-effectiveness ratio (ICER) calculations based on Quality-Adjusted Life Years (QALYs).

Results

A total of 71 patients with ruptured abdominal aortic aneurysm were identified, of whom 58 underwent surgical repair (OSR or EVAR). In Period A, all patients (n = 17) underwent open surgical repair. In Period B, 24 received OSR (58.5%) and 17 received EVAR (41.5%). The 30-day mortality rate was significantly lower in the EVAR group (5.9%) compared to OSR in both periods (63.3% and 50%, respectively; P = .001). The one-year mortality rate remained unchanged for EVAR but increased for OSR (P = .00075). Return-to-theatre rates were significantly higher in OSR patients (P = .044). ICER calculations showed EVAR to be cost-effective (−£202 526 per QALY within one year).

Conclusion

The introduction of a surgeon-led emergency EVAR service significantly improved early survival rates and reduced reintervention rates in rAAA patients while demonstrating cost-effectiveness compared to OSR.