Xavier Bonfill1,2,3, M Jesús Quintana4,2, Sergi Bellmunt5,6, Stefanie Suclupe1,3, Efrem Gómez7, Inés Fernandez de Valderrama8, Borja Castejón9, Manuel Miralles10, Eduardo Pérez11, José R Escudero3,7,12. 1. Department of Clinical Epidemiology and Public Health, de la Santa Creu i Sant Pau (IIB Sant Pau) University Hospital, Barcelona, Spain. 2. CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain. 3. Autonomous University of Barcelona, Barcelona, Spain. 4. Department of Clinical Epidemiology and Public Health, de la Santa Creu i Sant Pau (IIB Sant Pau) University Hospital, Barcelona, Spain - mjquintana@santpau.cat. 5. Department of Angiology, Vascular and Endovascular Surgery, Vall d'Hebron University Hospital, Barcelona, Spain. 6. Vall d'Hebron Research Institute (VHIR), Barcelona, Spain. 7. Joint Service of Angiology, Vascular and Endovascular Surgery, University Hospital Sant Pau-Hospital Dos de Maig, Barcelona, Spain. 8. 12 de Octubre University Hospital, Madrid, Spain. 9. Ramón y Cajal University Hospital, Madrid, Spain. 10. Department of Surgery, University of Valencia, Valencia, Spain. 11. Cruces University Hospital, Barakaldo, Spain. 12. CIBER of Cardiovascular Diseases (CIBERCV), Madrid, Spain.
Abstract
BACKGROUND: The aim of this study was to assess potential variability in the clinical characteristics and treatment of patients undergoing elective surgery for abdominal aortic aneurysm (AAA) across five hospitals in Spain. METHODS: Multicenter, retrospective cohort study of patients diagnosed with AAA and treated with open surgical repair (OSR) or endovascular aneurysm repair (EVAR). We evaluated clinical and demographic variables, including comorbidity (Charlson Comorbidity Index [CCI]); anatomic characteristics; surgical risk (ASA Score); aneurysm characteristics; and in-hospital and overall mortality. All patients were followed for three years. RESULTS: A total of 186 patients were included, mean age 72.5 (standard deviation [SD], 8.4), mean CCI 2.04 (SD, 1.9). The surgical technique was EVAR in 46.8% of cases (N.=87) and OSR in 53.2% (N.=99). The in-hospital mortality rate was 2.2%, with no differences between groups. The overall mortality rate during follow-up (mean, 2.9 years) was 24.1% for EVAR versus 8.1% for the OSR group (odds ratio [OR], 3.62; 95% confidence interval [CI], 3.60-3.64; P=0.004). EVAR was the only independent risk factor for mortality (OR, 3.89; 95% CI: 3.87-3.92; P=0.004). Inter-center variability in the type of surgery was high, with EVAR accounting for 19.4% to 75% of the surgical procedures, depending on the treating center (P<0.001). CONCLUSIONS: In this study the in-hospital mortality rates for elective EVAR and OSR were similar. However, after the follow-up, patients who underwent EVAR had a three-fold greater mortality rate than those treated with OSR. There was substantial inter-hospital variability, underscoring the need to standardize treatment selection in patients who undergo elective surgery for AAA repair.
BACKGROUND: The aim of this study was to assess potential variability in the clinical characteristics and treatment of patients undergoing elective surgery for abdominal aortic aneurysm (AAA) across five hospitals in Spain. METHODS: Multicenter, retrospective cohort study of patients diagnosed with AAA and treated with open surgical repair (OSR) or endovascular aneurysm repair (EVAR). We evaluated clinical and demographic variables, including comorbidity (Charlson Comorbidity Index [CCI]); anatomic characteristics; surgical risk (ASA Score); aneurysm characteristics; and in-hospital and overall mortality. All patients were followed for three years. RESULTS: A total of 186 patients were included, mean age 72.5 (standard deviation [SD], 8.4), mean CCI 2.04 (SD, 1.9). The surgical technique was EVAR in 46.8% of cases (N.=87) and OSR in 53.2% (N.=99). The in-hospital mortality rate was 2.2%, with no differences between groups. The overall mortality rate during follow-up (mean, 2.9 years) was 24.1% for EVAR versus 8.1% for the OSR group (odds ratio [OR], 3.62; 95% confidence interval [CI], 3.60-3.64; P=0.004). EVAR was the only independent risk factor for mortality (OR, 3.89; 95% CI: 3.87-3.92; P=0.004). Inter-center variability in the type of surgery was high, with EVAR accounting for 19.4% to 75% of the surgical procedures, depending on the treating center (P<0.001). CONCLUSIONS: In this study the in-hospital mortality rates for elective EVAR and OSR were similar. However, after the follow-up, patients who underwent EVAR had a three-fold greater mortality rate than those treated with OSR. There was substantial inter-hospital variability, underscoring the need to standardize treatment selection in patients who undergo elective surgery for AAA repair.
Authors: Aleksandra C Zoethout; Iris Hochstenbach; Maarten J van der Laan; Jean-Paul P M de Vries; Michel M P J Reijnen; Clark J Zeebregts Journal: J Endovasc Ther Date: 2021-09-27 Impact factor: 3.089