Editor's Choice - Variation in Intact Abdominal Aortic Aneurysm Repair Outcomes by Country: Analysis of International Consortium of Vascular Registries 2010 - 2016

Jonathan R Boyle; Jialin Mao; Adam W Beck; Maarit Venermo; Art Sedrakyan; Christian-Alexander Behrendt; Zoltan Szeberin; Nikolaj Eldrup; Marc Schermerhorn; Barry Beiles; Ian Thomson; Kevin Cassar; Martin Altreuther; Sebastian Debus; Amundeep S Johal; Sam Waton; Salvatore T Scali; David A Cromwell; Kevin Mani

doi:10.1016/j.ejvs.2021.03.034

Editor's Choice - Variation in Intact Abdominal Aortic Aneurysm Repair Outcomes by Country: Analysis of International Consortium of Vascular Registries 2010 - 2016

Eur J Vasc Endovasc Surg. 2021 Jul;62(1):16-24. doi: 10.1016/j.ejvs.2021.03.034. Epub 2021 Jun 16.

Authors

Jonathan R Boyle¹, Jialin Mao², Adam W Beck³, Maarit Venermo⁴, Art Sedrakyan², Christian-Alexander Behrendt⁵, Zoltan Szeberin⁶, Nikolaj Eldrup⁷, Marc Schermerhorn⁸, Barry Beiles⁹, Ian Thomson¹⁰, Kevin Cassar¹¹, Martin Altreuther¹², Sebastian Debus⁵, Amundeep S Johal¹³, Sam Waton¹³, Salvatore T Scali¹⁴, David A Cromwell¹³, Kevin Mani¹⁵

Affiliations

¹ Cambridge Vascular Unit, Cambridge University Hospitals NHS Trust & Department of Surgery, University of Cambridge, Cambridge, UK. Electronic address: jonboyle@doctors.org.uk.
² Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.
³ Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA.
⁴ Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland.
⁵ Department of Vascular Medicine, Working Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
⁶ Department of Vascular Surgery, Semmelweis University, Budapest, Hungary.
⁷ Department of Vascular Surgery, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
⁸ Division of Vascular Surgery and Endovascular Therapy, Beth Israel Deaconess Medical Centre, Boston, MA, USA.
⁹ Australasian Vascular Audit, Australasian Society for Vascular Surgery, Melbourne, Australia.
¹⁰ Department of Surgery, University of Otago, Dunedin, New Zealand.
¹¹ Department of Surgery, Faculty of Medicine and Surgery, University of Malta, Malta.
¹² Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway.
¹³ The Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, United Kingdom.
¹⁴ University of Florida College of Medicine, Division of Vascular Surgery & Endovascular Therapy, Gainesville, FL, USA.
¹⁵ Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.

PMID: 34144883
DOI: 10.1016/j.ejvs.2021.03.034

Abstract

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.

Keywords: Abdominal aortic aneurysm; EVAR; Mortality; Registry; Surgery.

Publication types

Research Support, U.S. Gov't, P.H.S.

MeSH terms

Age Factors
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal / mortality
Aortic Aneurysm, Abdominal / surgery*
Elective Surgical Procedures / statistics & numerical data*
Endovascular Procedures / statistics & numerical data*
Female
Hospital Mortality / trends
Humans
Male
Middle Aged
Prospective Studies
Registries / statistics & numerical data
Risk Factors
Sex Factors
Time Factors
Treatment Outcome

Abstract

Publication types

MeSH terms

Grants and funding