A Systematic Review and Meta-Analysis on 30-Day Readmission Rates After Endovascular Abdominal Aortic Aneurysm Repair and Open Repair

AIM: Endovascular aneurysm repair (EVAR) and open aneurysm repair (OAR) are established treatments for abdominal aortic aneurysm (AAA). This meta-analysis evaluated 30-day readmission, patient characteristics, postoperative complications, and length of stay after EVAR and OAR, and explored whether 30-day readmission may serve as a surrogate marker of healthcare quality. METHODS: Following Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, a systematic literature search of Embase, PubMed, Web of Science, and Cochrane databases was conducted from 1 January 2010 through 31 December 2024. Observational studies reporting 30-day readmission after elective EVAR and OAR were included. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). Pooled proportions and comparative effect estimates were calculated using random-effect models. Heterogeneity was assessed using the I2 statistic. Meta-analyses and meta-regression models evaluated associations between patient comorbidities, length of stay (LOS), postoperative complications, and 30-day readmission. RESULTS: Forty-nine studies reported outcomes after EVAR (578,744 patients) and OAR (228,683 patients). In procedure-specific pooled analyses, 30-day readmission rates were 8% after EVAR and 13% after OAR. LOS was shorter after EVAR than after OAR (mean 4.2 vs. 7.4 days; p < 0.001). No significant association was observed between length of stay and 30-day readmission for either OAR (effect estimate 0.0004, 95% CI [–0.0256–0.0265]; p = 0.973) or EVAR (effect estimate 0.0113, 95% CI [–0.0036–0.0262]; p = 0.136). Comorbidities including arterial hypertension, congestive heart failure, chronic kidney disease, and chronic obstructive pulmonary disease were significant predictors of readmission after both procedures. Study-level meta-regression suggested that postoperative stroke (EVAR), graft-related and cardiac complications, including myocardial infarction (EVAR and OAR), were significantly associated with higher 30-day readmission rates. Sensitivity analyses confirmed the stability of the pooled estimates, and no significant publication bias was detected. Data on 90-day readmission were too heterogeneous for pooled analysis. In direct comparative studies, random-effects meta-analysis showed no significant difference in 30-day readmission between EVAR and OAR (Odds Ratio [OR] 0.91, 95% CI [0.82–1.01]; I2 = 93.8%). CONCLUSIONS: EVAR was associated with lower pooled 30-day readmission rates and shorter hospital stays than OAR. However, direct comparative meta-analysis indicated no significant difference in 30-day readmission rates between procedures. At the study level, readmission was linked to patient comorbidity and postoperative complications, whereas no significant association was observed between length of stay and readmission. Given the observational design, substantial heterogeneity, and potential residual confounding, these findings should be interpreted with caution. Long-term outcomes were not assessed.