Ann Surg Treat Res.  2023 Jul;105(1):37-46. 10.4174/astr.2023.105.1.37.

Treatment of abdominal aortic aneurysms in Korea: a nationwide study

• Kim H
• Kwon TW
• Cho YP
• Gwon JG
• Han Y
• Lee SA
• Kim YJ
• Kim S

• KMID: 2544611
• DOI: http://doi.org/10.4174/astr.2023.105.1.37

Abstract

Purpose
Although endovascular aneurysm repair (EVAR) has been shown to be superior to open surgical repair (OSR) for abdominal aortic aneurysm (AAA) treatment, no large-scale studies in the Korean population have compared outcomes and costs.
Methods
The National Health Insurance Service database in Korea was screened to identify AAA patients treated with EVAR or OSR from 2008 to 2019. Perioperative, early postoperative, and long-term survival were compared, as were reinterventions and complications. Patients were followed-up through 2020.
Results
Of the 13,631 patients identified, 2,935 underwent OSR and 10,696 underwent EVAR. Perioperative mortality rate was lower in the EVAR group (4.2% vs. 8.0%, P < 0.001) even after excluding patients with ruptured AAA (2.7% vs. 3.3%, P = 0.003). However, long-term mortality rate per 100 person-years was significantly higher in the EVAR than in the OSR group (9.0 vs. 6.4, P < 0.001), and all-cause mortality was lower in the OSR group (hazard ratio, 0.9; 95% confidence interval, 0.87–0.97, P = 0.008). EVAR had a higher AAA-related reintervention rate per 100 person-years (1.75 vs. 0.52), and AAA-related reintervention costs were almost 10-fold higher with EVAR (US dollar [USD] 6,153,463) than with OSR (USD 624,216).
Conclusion
While EVAR may have short-term advantages, OSR may provide better long-term outcomes and costeffectiveness for AAA treatment in the Korean population, under the medical expense system in Korea.

Keyword

Abdominal aortic aneurysm; Costs and cost analysis; Endovascular aneurysm repair

Figure

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  Fig. 1 Flow diagram. NHIS, National Health Insurance Service; ICD-10, International Classification of Disease, 10th revision; AAA, abdominal aortic aneurysm.

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  Fig. 2 Annual number of procedures, including endovascular aneurysm repair (EVAR) and open surgical repair (OSR). (A) Total number of procedures; (B) the number of patients aged <60 years and ≥50 years; (C) the number of patients aged ≥60 years who underwent each procedure.

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  Fig. 3 All-cause mortality over time from 2009 to 2018 in (A) all patients, (B) patients with unruptured abdominal aortic aneurysm (AAA), and (C) patients with ruptured AAA. EVAR, endovascular aneurysm repair; OSR, open surgical repair.

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