Editor's Choice – Variation in Intact Abdominal Aortic Aneurysm Repair Outcomes by Country: Analysis of International Consortium of Vascular Registries 2010 – 2016,European Journal of Vascular and Endovascular Surgery

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Editor's Choice – Variation in Intact Abdominal Aortic Aneurysm Repair Outcomes by Country: Analysis of International Consortium of Vascular Registries 2010 – 2016
European Journal of Vascular and Endovascular Surgery ( IF 5.7 ) Pub Date : 2021-06-16 , DOI: 10.1016/j.ejvs.2021.03.034
Jonathan R Boyle ₁ , Jialin Mao ₂ , Adam W Beck ₃ , Maarit Venermo ₄ , Art Sedrakyan ₂ , Christian-Alexander Behrendt ₅ , Zoltan Szeberin ₆ , Nikolaj Eldrup ₇ , Marc Schermerhorn ₈ , Barry Beiles ₉ , Ian Thomson ₁₀ , Kevin Cassar ₁₁ , Martin Altreuther ₁₂ , Sebastian Debus ₅ , Amundeep S Johal ₁₃ , Sam Waton ₁₃ , Salvatore T Scali ₁₄ , David A Cromwell ₁₃ , Kevin Mani ₁₅

Affiliation

Cambridge Vascular Unit, Cambridge University Hospitals NHS Trust & Department of Surgery, University of Cambridge, Cambridge, UK.
Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.
Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland.
Department of Vascular Medicine, Working Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Department of Vascular Surgery, Semmelweis University, Budapest, Hungary.
Department of Vascular Surgery, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
Division of Vascular Surgery and Endovascular Therapy, Beth Israel Deaconess Medical Centre, Boston, MA, USA.
Australasian Vascular Audit, Australasian Society for Vascular Surgery, Melbourne, Australia.
Department of Surgery, University of Otago, Dunedin, New Zealand.
Department of Surgery, Faculty of Medicine and Surgery, University of Malta, Malta.
Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway.
The Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, United Kingdom.
University of Florida College of Medicine, Division of Vascular Surgery & Endovascular Therapy, Gainesville, FL, USA.
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.

Objective

Outcomes for intact abdominal aortic aneurysm (AAA) repair vary over time and by healthcare system, country, and surgeon. The aim of this study was to analyse peri-operative mortality for intact AAA repair in 11 countries over time and compare outcomes by gender, age, and geographical location.

Methods

Prospective data on primary repair of intact AAA were collected from 11 countries through the International Consortium of Vascular Registries (ICVR) and analysed for two time periods, 2010 – 2013 and 2014 – 2016. The primary outcome was peri-operative mortality after endovascular aneurysm repair (EVAR) and open surgical repair (OSR). Multivariable logistic regression models were used to adjust for differences in patient characteristics.

Results

A total of 103 715 patients were included. The percentage of patients undergoing EVAR increased from 63.6% to 71.2% (p < .001) over the study period. This proportion varied by country from 35% in Hungary to 81% in the United States. Overall peri-operative mortality decreased from 2.1% to 1.6 % (p < .001). Mortality also declined significantly over time for both OSR 4.2% to 3.6 % (p = .002) and EVAR 1.0% to 0.7% (p = .002). Mortality was significantly higher for female than male patients (3.0% vs. 1.6% p < .001). The percentage of patients > 80 years old undergoing AAA repair remained constant at 23.6% (p = .91). Peri-operative mortality was higher for patients > 80 years than for those < 80 years old (2.7% vs. 1.6% p < .001). Forty-six per cent (n = 275) of all EVAR deaths occurred in the over 80s.

Conclusion

The proportion of AAA repairs performed using EVAR has increased over time. Peri-operative mortality continues to decline for both OSR and EVAR. Outcomes however were significantly worse for both women and those aged over 80, so efforts should be focused on these patient groups to further reduce elective AAA mortality rates.

中文翻译：

编辑推荐 - 不同国家/地区完整腹主动脉瘤修复结果的差异：2010 - 2016 年国际血管登记联盟分析

客观的

完整腹主动脉瘤 (AAA) 修复的结果随时间和医疗保健系统、国家和外科医生的不同而不同。本研究的目的是分析 11 个国家完整 AAA 修复术的围手术期死亡率，并按性别、年龄和地理位置比较结果。

方法

通过国际血管登记联盟 (ICVR) 从 11 个国家收集完整 AAA 初级修复的前瞻性数据，并分析了 2010-2013 和 2014-2016 两个时间段。主要结果是血管内动脉瘤修复后的围手术期死亡率(EVAR) 和开放式手术修复 (OSR)。多变量逻辑回归模型用于调整患者特征的差异。

结果

共纳入 103 715 名患者。在研究期间，接受 EVAR 的患者百分比从 63.6% 增加到 71.2% ( p < .001)。这个比例因国家而异，从匈牙利的 35% 到美国的 81%。总体围手术期死亡率从 2.1% 降至 1.6% ( p < .001)。OSR 4.2% 至 3.6% ( p = .002) 和 EVAR 1.0% 至 0.7% ( p = .002)的死亡率也随着时间显着下降。女性患者的死亡率明显高于男性患者（3.0% vs. 1.6% p < .001）。80 岁以上接受 AAA 修复的患者比例保持在 23.6%（p = .91)。80 岁以上患者的围手术期死亡率高于 80 岁以下患者（2.7% vs. 1.6% p < .001）。46%（n = 275）的 EVAR 死亡发生在 80 多岁。