{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T18:26:02Z","timestamp":1785867962064,"version":"3.56.0"},"reference-count":9,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Device sales representatives (DSRs) play a key role in providing vascular surgeons with device-specific education, operational guidance, and troubleshooting support. However, industry relationships may introduce bias, raising ethical concerns. This study aimed to evaluate the clinical benefit of DSR presence in the operating room (OR) during standard, infrarenal endovascular aortic repair (EVAR). A retrospective, case-control study was conducted to assess the association between DSR presence and surgical outcomes in elective, infrarenal EVAR cases at an experienced endovascular institution. Preoperative (age, gender, ASA classification, and past medical history), perioperative (device company, OR and fluoroscopy time, and use of additional endografts or stents) and postoperative (length of hospital stay post-operation, endoleaks at six weeks and six months, and mortality at six months) variables were collected for cases between June 1st, 2019 to December 31st, 2022. Fisher\u2019s exact test, chi-squared test and student\u2019s t-test were used to compare DSR-present and control groups. Ninety standard infrarenal EVARs were included with a DSR present in 64 (71.1%) cases. Cook and Gore devices were used in roughly equal proportions with a single case using a Medtronic device. DSR presence was not associated with a statistically significant change in operative duration (p\u2009=\u20090.53) or fluoroscopy time (p\u2009=\u20090.95), or in rates of endograft usage (p\u2009=\u20090.35) or adjunctive stent use (p\u2009=\u20091.00). Length of hospital stay (p\u2009=\u20090.46), short- (p\u2009=\u20090.63) and long-term (p\u2009=\u20091.00) endoleaks, and mortality rates (p\u2009=\u20091.00) were similar between groups. In this study of standard, infrarenal EVAR procedures at a high volume endovascular centre, DSR presence was not associated with statistically significant differences in case efficiency, device utilization or clinical outcomes. These findings suggest that routine DSR involvement in such procedures may not provide a clear clinical advantage. In light of important ethical considerations, the study calls for a more selective use of DSR support and for larger, multicentre studies to better understand their role in EVAR cases.<\/jats:p>","DOI":"10.1371\/journal.pone.0355214","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T17:24:01Z","timestamp":1785864241000},"page":"e0355214","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of device sales representatives in the operating room on clinical outcomes during standard endovascular aneurysm repair: A retrospective case-control study"],"prefix":"10.1371","volume":"21","author":[{"given":"Farhad","family":"Udwadia","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2388-3909","authenticated-orcid":true,"given":"Annudesh","family":"Liyanage","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary K.","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"issue":"3","key":"pone.0355214.ref001","first-page":"182","article-title":"Has open vascular surgery disappeared?","volume":"108","author":"WK Nichols","year":"2011","journal-title":"Mo Med"},{"issue":"3","key":"pone.0355214.ref002","doi-asserted-by":"crossref","first-page":"939","DOI":"10.3390\/jcm14030939","article-title":"The Evolution of Vascular Interventional Radiology and Endovascular Surgery: An Overview of Recent Advances","volume":"14","author":"\u00c1 Sz\u0151nyi","year":"2025","journal-title":"J Clin Med"},{"key":"pone.0355214.ref003","doi-asserted-by":"crossref","first-page":"100079","DOI":"10.1016\/j.jvsvi.2024.100079","article-title":"Physician-industry relationships in vascular surgery","volume":"2","author":"JR Stern","year":"2024","journal-title":"JVS-Vascular Insights"},{"issue":"9","key":"pone.0355214.ref004","article-title":"Device Sales Representatives in the Operating Room: Do We Really Need or Want Them? A Survey of Orthopaedic Trauma Surgeons","volume":"31","author":"BR Moed","year":"2017","journal-title":"J Orthop Trauma"},{"issue":"8","key":"pone.0355214.ref005","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0158510","article-title":"Salespeople in the Surgical Suite: Relationships between Surgeons and Medical Device Representatives","volume":"11","author":"B O\u2019Connor","year":"2016","journal-title":"PLoS One"},{"issue":"3","key":"pone.0355214.ref006","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1111\/jlme.12076","article-title":"Physicians under the influence: social psychology and industry marketing strategies","volume":"41","author":"S Sah","year":"2013","journal-title":"J Law Med Ethics"},{"key":"pone.0355214.ref007","doi-asserted-by":"crossref","first-page":"100211","DOI":"10.1016\/j.jvsvi.2025.100211","article-title":"Canadian Vascular Surgeons\u2019 perspective on the impact on device representatives in the operating room","volume":"3","author":"FR Udwadia","year":"2025","journal-title":"JVS-Vascular Insights"},{"issue":"3","key":"pone.0355214.ref008","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1111\/anae.14569","article-title":"A review of ASA physical status - historical perspectives and modern developments","volume":"74","author":"D Mayhew","year":"2019","journal-title":"Anaesthesia"},{"key":"pone.0355214.ref009","first-page":"1932","article-title":"Association between physicians\u2019 interaction with pharmaceutical companies and their clinical practices: A systematic review and meta-analysis.","author":"H Brax","year":"2017","journal-title":"Plos One"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0355214","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T17:24:03Z","timestamp":1785864243000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0355214"}},"subtitle":[],"editor":[{"given":"Bo","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":9,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,4]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0355214","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]}}}