1. A Comparison Of Endovascular And Open Approaches To The Treatment Of Aneurysms Of The Descending Aorta: Outcomes Differ By Severity Of Co-morbid Diseases American Association for Thoracic Surgery: Aortic Symposium April 26-27, 2012 Alexander Iribarne, MD; Mohammad Hashmi, MD; Ross Milner, MD; Ajeet Singh; Aurelie Merlo; Darwin Eton, MD; Robert Steppacher, MD; Christopher Skelly, MD; Allan Stewart, Mark J. Russo, MD, MS 1 Section of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, IL 2 Center for Aortic Diseases, University of Chicago, Chicago, IL 3 Aortic Surgery Program, Columbia University Medical Center, New York, NY

2. The authors have no relevant financial relationships to disclose. Introduction Methods Results Conclusions DISCLOSURES

3. OBJECTIVES Introduction Methods Results Conclusions Compare clinical outcomes and costs associated with open (OPEN) versus endovascular (ENDO) treatment of aneurysms of the descending aorta in a national cohort of patients Determine if comparative effectiveness was impacted by severity-of-comorbid- illness (SOCI)

4. Introduction Methods Results Conclusions STUDY POPULATION Data Source Nationwide Inpatient Sample (2008) Study population was patients treated for non- ruptured aneurysm of the descending aorta defined by ICD-9CM codes OPEN - 38.45 ENDO - 39.73 OPEN2,80574.19% ENDO97625.81% Total3,781-

5. Introduction Methods Results Conclusions SOCI Patients were further stratified by severity of comorbid illness (SOCI) according to 3M APR-DRG classification: Minor, Moderate. Major, Extreme This classification creates a common measurement across disparate patient types that reflect the cross-section of acute care patients. Patients treated for non-ruptured aneurysm of the descending aorta in 2008 by SOCI level Minor52013.75% Moderate78920.87% Major1,04027.51% Extreme1,43237.87%

6. Introduction Methods Results Conclusions OUTCOMES Primary outcomes: In-hospital mortality Inpatient cost

7. Introduction Methods Results Conclusions IN-HOSPITAL MORTALITY MinorModerateMajorExtremeTotal Open%1.3%1.6%6.5%24.6%9.1% Endo%1.5%1.0%1.9%7.7%6.0% Total1.3%1.5%6.1%16.1%8.3% p*0.9240.6410.059< 0.0010.002

8. Introduction Methods Results Conclusions COST In $10ksMinorModerateMajorExtremeTotal Open mean +/- SD 39.0 +/- 17.2 47.6 +/- 27.6 66.8 +/- 46.8 110.8 +/- 83.0 68.5 +/- 58.3 Endo mean +/- SD 37.4 +/- 19.8 56.9 +/- 42.0 81.8 +/- 50.9 62.2 +/- 58.0 61.9 +/- 54.8 mean +/- SD 38.8 +/- 17.5 48.8 +/- 29.9 68.2 +/- 47.4 86.5 +/- 75.6 66.8 +/- 57.5 p*0.4926< 0.001 0.003

9. Introduction Methods Results Conclusions SUMMARY Overall in-hospital survival was better in the ENDO patients However, comparative effectiveness differed by severity of illness level between ENDO and OPEN in stratified analysis the survival benefit as limited to the Major and Extreme groups

10. Introduction Methods Results Conclusions SUMMARY In the Extreme group, inpatient survival was better and costs were less with ENDO. In the Moderate group, inpatient survival was equivalent and costs were less with OPEN.

11. Introduction Methods Results Conclusions CONCLUSION When both options are technically feasible, a patient’s severity-of-comorbid-illness disease should be considered when selecting the treatment approach. In patients with greater severity of comorbid illness, endovascular treatment is associated with better in-hospital survival and lower cost