Abstract
Purpose:
We sought to compare the costs of ambulatory endovascular aneurysm repair (a-EVAR) and inpatient EVAR (i-EVAR) at up to 1-year of follow-up.
Materials and Methods:
A retrospective cohort study of consecutive patients undergoing elective EVAR between April 2016 and December 2018 at two academic centers. Patients planned for a-EVAR were compared with i-EVAR. Costs at 30 days and 1 year were extracted. These included operating room (OR) use, bed occupancy, laboratory and imaging, emergency department (ED) visits, readmissions, and reinterventions. Baseline characteristics were compared. Multiple regression model was used to identify predictors of increased EVAR costs. Repeated measures analysis of variance (ANOVA) was used to compare cost differences at 30 days and 1 year via an intention-to-treat analysis. Bonferroni post hoc test compared between-group differences. A p value<0.05 was considered statistically significant.
Results:
One hundred seventy patients were included. Most underwent percutaneous EVAR (>94%) under spinal anesthesia (>84%). Ambulatory endovascular aneurysm repair was successful in 84% (84/100). Ambulatory endovascular aneurysm repair patients (76±8 years) were younger than i-EVAR (78±9 years). They also had a smaller mean aneurysm diameter (56±6 mm) compared with i-EVAR (59±6 mm). Emergency department visits, readmissions, and reinterventions were similar up to 1 year (all p=NS). Ambulatory endovascular aneurysm repair costs showed a non-statistically significant reduction in total costs at 30 days and 1 year by 27% and 21%, respectively. Patients younger than 85 years and males had a 30-day cost reduction by 34% (p=0.027) and 33% (p=0.035), respectively with a-EVAR.
Conclusions:
Same-day discharge is feasible and successful in selected patients. Patients younger than 85 years and males have a short-term cost benefit with EVAR done in the ambulatory setting without increased complications or reinterventions.
Clinical Impact
This study shows the overall safety of ambulatory EVAR with proper patient selection. These patient had similar post-intervention complications to inpatients. Same day discharge also resulted in short-term reduction in costs in male patients and patients younger than 85 years.
Keywords: endovascular aneurysm repair, hospital costs, same-day discharge, cost analysis, abdominal aortic aneurysm
Introduction
Endovascular aneurysm repair (EVAR) has been a rapidly adopted technology with lower morbidity and mortality compared with open surgical repair (OSR) of abdominal aortic aneurysms (AAAs) in both randomized and non-randomized studies.1–4 Endovascular aneurysm repair also offers the advantage of a shortened hospital length of stay (LOS) and has surpassed OSR in terms of procedure volume.1,5 The value gained from lower morbidity, mortality, and LOS is met with high endografts’ costs, imaging surveillance costs, and reintervention rates.6–8 Data from the Open Versus Endovascular Repair (OVER) trial suggests that EVAR is still less expensive than OSR at 2 years. 9 On the other hand, Endovascular Aneurysm Repair Trial 1 (EVAR-1) suggests that it is costlier than OSR beyond 10 years with hospital stay amongst drivers of cost. 1 Despite these mixed results, there is an observed reduction in EVAR costs over time. 10 Bed occupancy constitutes up to 20% of total hospital costs in EVAR even with shorter LOS.2,11–13 Hence, shortening LOS emerged as a strategy to reduce costs.14,15 Our aim was to determine whether ambulatory (a-EVAR) will cost less than inpatient (i-EVAR) at 30 days and 1 year post-EVAR.
Materials and Methods
Consecutive patients scheduled for elective EVAR at two academic centers between April 2016 and December 2018 were retrospectively analyzed. Institutional ethical approvals were obtained. The inclusion criteria, based on our previous published experience studying the clinical safety of ambulatory EVAR, 16 was: infrarenal AAA planned for elective EVAR, availability of a caregiver for the first 24 hours after discharge who is reliable to call or return the patient to hospital in the event of a complication. Thoraco-abdominal aortic repairs, thoracic aortic repair, and non-elective EVAR were excluded.
Data Collection
Average costs encompassed operating room (OR), hospital stay, emergency department (ED) visits, reinterventions, and readmissions. The perioperative period was defined as the time between index visit up to 30 days. Variables were retrospectively collected, including demographics, perioperative costs, and 1-year costs. All costs are reported in Canadian dollars (1 Canadian dollar equals to 0.79 US dollars and 0.70 Euros).
Data Analysis
Analysis was performed in an intention-to-treat manner comparing a-EVAR versus i-EVAR. Baseline characteristics were compared using independent t-test, chi-square test, and Mann-Whitney U test when appropriate. Continuous variables were reported as mean with standard deviation or median with inter-quartile range depending on data distribution. Multiple regression model was used to identify predictors of increased EVAR costs. Repeated measures analysis of variance (ANOVA) was used to compare cost differences at 30 days and 1 year via an intention-to-treat analysis. Bonferroni post hoc test compared between-group differences. Analysis was performed using Statistical Package for the Social Sciences (SPSS) Version 27 (IBM, Armonk, NY, USA). A p value<0.05 was considered statistically significant.
Results
Baseline Characteristics
The baseline and procedural characteristics are shown in Table 1. Ambulatory endovascular aneurysm repair accounted for 59% (n=100/170) of the patients. Patients in the a-EVAR cohort had a smaller AAA (56±6 vs 59±6 mm, p=0.011) and shorter median LOS (0.5 vs 1.3 days, p<0.001).
Table 1.
Baseline Characteristics of a-EVAR and i-EVAR Patients.
| a-EVAR (n=100) | i-EVAR (n=70) | p value | |
|---|---|---|---|
| Age in years, mean (SD) | 76 (8) | 78 (9) | 0.101 |
| Male sex, n (%) | 81 (81%) | 57 (81%) | 0.944 |
| Comorbidities, n(%) | |||
| DM | 18 (18%) | 18 (26%) | 0.226 |
| Hypertension | 72 (72%) | 53 (76%) | 0.589 |
| Dyslipidemia | 45 (45%) | 37 (53%) | 0.313 |
| CAD | 34 (34%) | 23 (33%) | 0.877 |
| CKD | 14 (14%) | 13 (19%) | 0.422 |
| Stroke | 4 (4%) | 8 (11%) | 0.063 |
| Cancer | 16 (16%) | 12 (17%) | 0.843 |
| COPD | 25 (25%) | 23 (33%) | 0.263 |
| CHF | 4 (4%) | 7 (10%) | 0.118 |
| Arrhythmia | 16 (16%) | 13 (19%) | 0.661 |
| AAA diameter in mm, mean (SD) | 56 (6) | 59 (6) | 0.011 |
| LOS in days, median (IQR) | 0.5 (0.4–0.8) | 1.3 (1.2–2.3) | <0.001 |
| Anesthesia type, n (%) | 0.950 | ||
| General | 10 (10%) | 8 (11%) | |
| Spinal | 86 (86%) | 59 (84%) | |
| Local | 4 (4%) | 3 (4%) | |
| Percutaneous access, n (%) | 96 (96%) | 66 (94%) | 0.603 |
Abbreviations: AAA, abdominal aortic aneurysm; CAD, coronary artery disease; CHF, congestive heart failure; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; DM, diabetes mellitus; IQR, inter-quartile range; LOS, length of stay; SD, standard deviation.
Reasons for Failed a-EVAR
Ambulatory endovascular aneurysm repair failure to discharge occurred in 16 patients. Procedure-related (n=10) factors were conversion to aorto-uni-iliac endograft (n=3), leg ischemia (n=2), groin hematoma (n=2), inadvertent renal artery coverage (n=1), urinary catheter-related injury (n=1), and endoleak on completion angiogram (n=1). All three patients converted to aorto-uni-iliac repair had failure of contralateral gate cannulation on the original bifurcated endograft. The patients with leg ischemia and groin hematoma were as a result of percutaneous access complications; both patients with leg ischemia required femoral exploration and primary repair. Non-procedure-related factors (n=5) were patients living far (n=3) and old age (n=2). No reason was identified for one patient.
Thirty-Day and 1-Year EVAR Complication Rates
The 30-day and 1-year rates of ED visits, readmission, and reinterventions were similar between the two cohorts (Supplemental Table 1). At 1 year, there was a non-significant increase in reinterventions (17% a-EVAR and 9% i-EVAR).
Cost Differences at 30 Days and 1 Year
Cost details are shown in Tables 2 and 3, and Supplemental Figures 1 and 2. Operative costs were similar both at 30 days and 1 year. There was a reduction in the costs of laboratory tests by 62% in the a-EVAR cohort at 30 days. There was also a trend toward reduced costs of ward stay, pharmacy, and ED visits at 30 days. Total perioperative costs were 27% less expensive (12 326 vs 16 843), but the finding was not statistically significant. There was a similar non-statistically significant reduction by 21% at 1 year (13 907 vs 17 641).
Table 2.
Cost Breakdown at 30 Days.
| a-EVAR (n=100) | i-EVAR (n=70) | p value | |
|---|---|---|---|
| Operative | 11 816 (3314) | 12 978 (4517) | 0.312 |
| Bed occupancy | |||
| PACU | 542 (499) | 549 (372) | 0.921 |
| Ward stay | 236 (896) | 1808 (7294) | 0.077 |
| Supportive services | |||
| Blood bank | 64 (260) | 259 (1483) | 0.280 |
| Imaging | 189 (218) | 299 (530) | 0.103 |
| Intervention | 620 (3424) | 336 (412) | 0.491 |
| Labs | 35 (102) | 92 (212) | 0.038 |
| Pharmacy | 135 (264) | 726 (2828) | 0.086 |
| Ancillary care | 225 (363) | 614 (2398) | 0.183 |
| Follow up in clinic | 36 (75) | 101 (400) | 0.183 |
| ED | 106 (461) | 136 (540) | 0.081 |
| Total | 12 326 (7110) | 16 843 (22 290) | 0.105 |
Abbreviations: ED, emergency department; PACU, post-anesthesia care unit.
Table 3.
Cost Breakdown at 1 Year.
| a-EVAR (n=100) | i-EVAR (n=70) | p value | |
|---|---|---|---|
| Operative | 12 587 (5623) | 12 978 (4517) | 0.793 |
| Bed occupancy | |||
| PACU | 561 (505) | 549 (372) | 0.862 |
| Ward stay | 591 (2021) | 2050 (8761) | 0.175 |
| Supportive services | |||
| Blood bank | 107 (460) | 260 (1482) | 0.332 |
| Imaging | 387 (482) | 403 (616) | 0.850 |
| Intervention | 686 (3438) | 360 (470) | 0.433 |
| Labs | 69 (160) | 123 (265) | 0.095 |
| Pharmacy | 205 (416) | 771 (2957) | 0.116 |
| Ancillary care | 337 (621) | 721 (2928) | 0.283 |
| Follow-up in clinic | 112 (168) | 170 (500) | 0.351 |
| ED | 269 (896) | 192 (582) | 0.533 |
| Total | 13 907 (8864) | 17 641 (25 067) | 0.171 |
Abbreviations: ED, emergency department; PACU, post-anesthesia care unit.
Factors Associated With Increased EVAR Costs
A multiple regression model was run to predict factors associated with increased costs at 1 year. Variables included were age, sex, AAA diameter, 30-day reintervention, 30-day readmission, 30-day ED visits, and failed a-EVAR. The model predicted 1-year costs, F(7,85)=6.931, p<0.001, R2=0.311. Age>85 years (t=2.343, p=0.021), female sex (t=2.175, p=0.032), and 30-day ED visits (t=2.808, p=0.006) predicted increased costs. Failed a-EVAR did not predict increased costs (t=0.963, p=0.338).
A-EVAR Versus i-EVAR Costs
Repeated measures ANOVA showed a non-statistically significant reduction in EVAR costs (Figure 1) with a-EVAR at 30 days (mean difference –4517, p=0.060) and 1 year (mean difference –3734, p=0.171). When the analysis is performed considering sex and age, a-EVAR patients who were younger than 85 years had a 34% reduction in EVAR costs at 30 days (mean difference –6072, p=0.027) but not at 1 year (mean difference –5612, p=0.073). Male sex also showed a similar 33% cost reduction at 30 days (mean difference –5905, p=0.035) but not at 1 year (mean difference –5.502, p=0.085). These findings are shown in Figures 2 and 3.
Figure 1.
Comparison of 30-day and 1-year costs in a-EVAR and i-EVAR patients.
Abbreviations: a-EVAR, ambulatory endovascular aneurysm repair; i-EVAR, inpatient endovascular aneurysm repair.
Figure 2.
Comparison of 30-day and 1-year costs in a-EVAR and i-EVAR patients younger than 85 years (asterisks indicate difference statistically significant).
Abbreviations: a-EVAR, ambulatory endovascular aneurysm repair; i-EVAR, inpatient endovascular aneurysm repair.
Figure 3.
Comparison of 30-day and 1-year costs in a-EVAR and i-EVAR male patients (asterisks indicate difference statistically significant).
Abbreviations: a-EVAR, ambulatory endovascular aneurysm repair; i-EVAR, inpatient endovascular aneurysm repair.
Discussion
This study describes factors associated with cost reduction in patients undergoing a-EVAR in a system with established same-day discharge clinical pathways. These pathways facilitate discharge after a short post-anesthesia care unit (PACU) stay and can reduce bed occupancy costs by up to 35%.17,18 We noted that a-EVAR patients had smaller mean AAA size compared with i-EVAR. Despite AAA diameter not being an inclusion criteria, this likely reflects perceived higher complexity of EVAR with larger aneurysms and longer operative time, as previously reported in a large observational study by Columbo et al. 17 These a-EVAR patients had a shorter median LOS of 0.5 days compared with 1.3 days in i-EVAR, reflecting modern reported EVAR LOS in literature. 19 In this study, percutaneous access was utilized in the majority of patients and is likely one of the factors responsible for this observed short LOS. 20
In terms of costs, a-EVAR costs were similar to i-EVAR at 30 days and 1 year. Cost breakdown identified operative costs as the main drivers of cost for both groups. These findings are similar to previous literature.15,21 Supportive non-operative costs have been previously observed to cost less in patients discharged on the same day as well. 22 This observation was reproduced in our study with laboratory, pharmacy, and post-operative ward stay being less expensive with a-EVAR. This likely reflects more refined standardized post-operative pathways. We noted that the benefit of a-EVAR in reducing costs was only evident in patients younger than 85 years and males. The effects of age and sex as predictors of increased costs have not been previously studied. We postulate that lack of cost reductions in females is related to a higher incidence of procedure-related complications.23,24 Poor female representation in studies has been recognized as a limitation in EVAR literature. 9
a-EVAR success was 84% in our cohort. Lachat et al 25 and Hanley et al 16 reported a 92% and 85% same-day discharge success rate, respectively, in patients undergoing EVAR. The profile of patients included in these two studies were very similar to ours with exclusion of patients with complex AAA anatomy, severe comorbidities and patients with poor access to the ED in case of post-operative complications.16,25 In terms of costs, planned but failed a-EVAR did not predict increased EVAR costs compared with planned i-EVAR. This could be explained by the fact that majority of the reasons for failure in our study, such as conversion to aorto-uni-iliac repair, access hematoma, traumatic urinary catheterization, and the fact that the patient lives far do not require prolonged treatment or intervention; rather just a transition to i-EVAR. Montross et al 26 noted a similar finding where only adverse events which required treatment longer than 6 hours predicted against candidacy for same-day discharge.
A review of short stay EVAR by Shaw et al 27 concluded that it is safe in the low risk patient and results in significant cost reduction. Our study adds to the existing literature as it reports a large institutional experience with a-EVAR. It consolidates the notion that same-day discharge is safe in selected patients.16,18,22,26,28 It also identifies up to one-third cost benefit in patients who are younger than 85 years and males in the short-term.
Conclusion
Same-day discharge is feasible and successful in selected patients. Same-day discharge EVAR shows a trend toward reduced total costs in the short-term, specifically in non-operative costs. Patients younger than 85 years and males show significant short-term cost benefit with EVAR done in the ambulatory setting without increased complications or reinterventions.
Supplemental Material
Supplemental material, sj-docx-1-jet-10.1177_15266028221133694 for Feasibility and Cost Analysis of Ambulatory Endovascular Aneurysm Repair by Ahmed A. Naiem, R.J. Doonan, Andre Guigui, Daniel I. Obrand, Jason P. Bayne, Kent S. MacKenzie, Oren K. Steinmetz, Elie Girsowicz and Heather L. Gill in Journal of Endovascular Therapy
Supplemental material, sj-jpg-2-jet-10.1177_15266028221133694 for Feasibility and Cost Analysis of Ambulatory Endovascular Aneurysm Repair by Ahmed A. Naiem, R.J. Doonan, Andre Guigui, Daniel I. Obrand, Jason P. Bayne, Kent S. MacKenzie, Oren K. Steinmetz, Elie Girsowicz and Heather L. Gill in Journal of Endovascular Therapy
Supplemental material, sj-jpg-3-jet-10.1177_15266028221133694 for Feasibility and Cost Analysis of Ambulatory Endovascular Aneurysm Repair by Ahmed A. Naiem, R.J. Doonan, Andre Guigui, Daniel I. Obrand, Jason P. Bayne, Kent S. MacKenzie, Oren K. Steinmetz, Elie Girsowicz and Heather L. Gill in Journal of Endovascular Therapy
Acknowledgments
The authors would like to acknowledge the incredible help retrieving costs data provided by Stacey Davies from the Integrated Health & Social Services University Center for Center-West Montreal.
Footnotes
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
Prior Presentations: Canadian Society for Vascular Surgery Hybrid Meeting—September 2021
European Society for Vascular Surgery Annual Meeting—September 2021
ORCID iDs: Ahmed A. Naiem 
https://orcid.org/0000-0002-4544-0582
Heather L. Gill
https://orcid.org/0000-0001-7398-8767
Supplemental Material: Supplemental material for this article is available online.
References
- 1. Patel R, Powell JT, Sweeting MJ, et al. The UK EndoVascular Aneurysm Repair (EVAR) randomised controlled trials: long-term follow-up and cost-effectiveness analysis. Health Technol Assess. 2018;22(5):1–132. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Lederle FA, Freischlag JA, Kyriakides TC, et al. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA. 2009;302(14):1535–1542. [DOI] [PubMed] [Google Scholar]
- 3. Chang DC, Easterlin MC, Montesa C, et al. Adoption of endovascular repair of abdominal aortic aneurysm in California: lessons for future dissemination of surgical technology. Ann Vasc Surg. 2012;26(4):468–475. [DOI] [PubMed] [Google Scholar]
- 4. Siracuse JJ, Gill HL, Graham AR, et al. Comparative safety of endovascular and open surgical repair of abdominal aortic aneurysms in low-risk male patients. J Vasc Surg. 2014;60(5):1154–1158. [DOI] [PubMed] [Google Scholar]
- 5. Suckow BD, Goodney PP, Columbo JA, et al. National trends in open surgical, endovascular, and branched-fenestrated endovascular aortic aneurysm repair in Medicare patients. J Vasc Surg. 2018;67(6):1690–1697.e1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. Dryjski M, O’Brien-Irr MS, Hassett J. Hospital costs for endovascular and open repair of abdominal aortic aneurysm. J Am Coll Surg. 2003;197(1):64–70. [DOI] [PubMed] [Google Scholar]
- 7. Angle N, Dorafshar AH, Moore WS, et al. Open versus endovascular repair of abdominal aortic aneurysms: what does each really cost? Ann Vasc Surg. 2004;18(5):612–618. [DOI] [PubMed] [Google Scholar]
- 8. Seiwert AJ, Wolfe J, Whalen RC, et al. Cost comparison of aortic aneurysm endograft exclusion versus open surgical repair. Am J Surg. 1999;178(2):117–120. [DOI] [PubMed] [Google Scholar]
- 9. Stroupe KT, Lederle FA, Matsumura JS, et al. Cost-effectiveness of open versus endovascular repair of abdominal aortic aneurysm in the OVER trial. J Vasc Surg. 2012;56(4):901–909.e2. [DOI] [PubMed] [Google Scholar]
- 10. Jayarajan SN, Vlada CA, Sanchez LA, et al. National temporal trends and determinants of cost of abdominal aortic aneurysm repair. Vascular. 2020;28(6):697–704. [DOI] [PubMed] [Google Scholar]
- 11. Patel ST, Haser PB, Bush HL, et al. The cost-effectiveness of endovascular repair versus open surgical repair of abdominal aortic aneurysms: A decision analysis model. J Vasc Surg. 1999;29(6):958–972. [DOI] [PubMed] [Google Scholar]
- 12. Lemmon GW, Neal D, DeMartino RR, et al. Variation in hospital costs and reimbursement for endovascular aneurysm repair: A Vascular Quality Initiative pilot project. J Vasc Surg. 2017;66(4):1073–1082. [DOI] [PubMed] [Google Scholar]
- 13. Roche-Nagle G, Hazel M, Rajan DK. Financial impact of PEVAR compared with standard endovascular repair in Canadian hospitals. Can Assoc Radiol J. 2018;69(2):215–219. [DOI] [PubMed] [Google Scholar]
- 14. Sternbergh WC, III, Money SR. Hospital cost of endovascular versus open repair of abdominal aortic aneurysms: a multicenter study. J Vasc Surg. 2000;31(2):237–244. [DOI] [PubMed] [Google Scholar]
- 15. Warner CJ, Horvath AJ, Powell RJ, et al. Endovascular aneurysm repair delivery redesign leads to quality improvement and cost reduction. J Vasc Surg. 2015;62(2):285–289. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16. Hanley SC, Steinmetz O, Mathieu ES, et al. Safety and feasibility of endovascular aortic aneurysm repair as day surgery. J Vasc Surg. 2018;67(6):1709–1715. [DOI] [PubMed] [Google Scholar]
- 17. Columbo JA, Martinez-Camblor P, O’Malley AJ, et al. Long-term reintervention after endovascular abdominal aortic aneurysm repair. Ann Surg. 2021;274(1):179–185. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18. Lo TC, Hsin CH, Shie RF, et al. Outpatient percutaneous endovascular abdominal aortic aneurysm repair: a single-center experience. J Vasc Interv Radiol. 2021;32(3):466–471. [DOI] [PubMed] [Google Scholar]
- 19. Edwards MS, Andrews JS, Edwards AF, et al. Results of endovascular aortic aneurysm repair with general, regional, and local/monitored anesthesia care in the American College of Surgeons National Surgical Quality Improvement Program database. J Vasc Surg. 2011;54(5):1273–1282. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20. Hong JC, Yang GK, Delarmente BA, et al. Cost-minimization study of the percutaneous approach to endovascular aortic aneurysm repair. J Vasc Surg. 2020;71(2):444–449. [DOI] [PubMed] [Google Scholar]
- 21. Itoga NK, Tang N, Patterson D, et al. Episode-based cost reduction for endovascular aneurysm repair. J Vasc Surg. 2019;69(1):219–225.e1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22. Moscato VP, O’Brien-Irr MS, Dryjski ML, et al. Potential clinical feasibility and financial impact of same-day discharge in patients undergoing endovascular aortic repair for elective infrarenal aortic aneurysm. J Vasc Surg. 2015;62(4):855–861. [DOI] [PubMed] [Google Scholar]
- 23. Pouncey AL, David M, Morris RI, et al. Editor’s choice—systematic review and meta-analysis of sex specific differences in adverse events after open and endovascular intact abdominal aortic aneurysm repair: consistently worse outcomes for women. Eur J Vasc Endovasc Surg. 2021;62(3):367–378. [DOI] [PubMed] [Google Scholar]
- 24. Ramkumar N, Suckow BD, Arya S, et al. Association of sex with repair type and long-term mortality in adults with abdominal aortic aneurysm. JAMA Netw Open. 2020;3(2):e1921240. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25. Lachat ML, Pecoraro F, Mayer D, et al. Outpatient endovascular aortic aneurysm repair: experience in 100 consecutive patients. Ann Surg. 2013;258(5):754–8; discussion 758–759. [DOI] [PubMed] [Google Scholar]
- 26. Montross BC, O’Brien-Irr MS, Koudoumas D, et al. The selection of patients for ambulatory endovascular aneurysm repair of elective asymptomatic abdominal aortic aneurysm. J Vasc Surg. 2020;72(4):1347–1353. [DOI] [PubMed] [Google Scholar]
- 27. Shaw SE, Preece R, Stenson KM, et al. Short stay EVAR is safe and cost effective. Eur J Vasc Endovasc Surg. 2019;57:368-373. [DOI] [PubMed] [Google Scholar]
- 28. Al-Zuhir N, Wong J, Nammuni I, et al. Selection, thirty day outcome and costs for short stay endovascular aortic aneurysm repair (SEVAR). J Eur Soc Vasc Surg. 2012;43(6):662–665. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Supplemental material, sj-docx-1-jet-10.1177_15266028221133694 for Feasibility and Cost Analysis of Ambulatory Endovascular Aneurysm Repair by Ahmed A. Naiem, R.J. Doonan, Andre Guigui, Daniel I. Obrand, Jason P. Bayne, Kent S. MacKenzie, Oren K. Steinmetz, Elie Girsowicz and Heather L. Gill in Journal of Endovascular Therapy
Supplemental material, sj-jpg-2-jet-10.1177_15266028221133694 for Feasibility and Cost Analysis of Ambulatory Endovascular Aneurysm Repair by Ahmed A. Naiem, R.J. Doonan, Andre Guigui, Daniel I. Obrand, Jason P. Bayne, Kent S. MacKenzie, Oren K. Steinmetz, Elie Girsowicz and Heather L. Gill in Journal of Endovascular Therapy
Supplemental material, sj-jpg-3-jet-10.1177_15266028221133694 for Feasibility and Cost Analysis of Ambulatory Endovascular Aneurysm Repair by Ahmed A. Naiem, R.J. Doonan, Andre Guigui, Daniel I. Obrand, Jason P. Bayne, Kent S. MacKenzie, Oren K. Steinmetz, Elie Girsowicz and Heather L. Gill in Journal of Endovascular Therapy