Anderson Patrice L, Arons Raymond R, Moskowitz Alan J, Gelijns Annetine, Magnell Corey, Faries Peter L, Clair Dan, Nowygrod Roman, Kent K Craig
International Center for Health Outcomes and Innovation Research, College of Physicians and Surgeons, and Mailman School of Public Health, Columbia University, 600 W. 168th Street, 7th Floor, New York, NY 10032, USA.
J Vasc Surg. 2004 Jan;39(1):10-9. doi: 10.1016/j.jvs.2003.07.020.
The purpose of this study was to compare survival and outcomes of endovascular versus open repair of abdominal aortic aneurysms (AAAs) in New York State (NYS).
We used the NYS discharge dataset Statewide Planning and Research Cooperative System (SPARCS) to analyze the outcomes of elective admission for nonruptured (International Classification of Diseases-9th revision [ICD-9] 441.4) open aneurysm repair (38.44) and endovascular aneurysm repair (39.71) during the years 2000-2002. The ICD-9 code for endovascular repair was introduced in late 2000, thus capturing 3 months of empiric data for 2000.
There has been a significant increase in the number of AAA procedures performed in NYS (comparing before and after 2000: average, 1419 vs 1701; P =.0001), temporally coinciding with the implementation of training programs after US Food and Drug Administration approval of endovascular grafts and the new payment code. From 2000 to 2002 the number of NYS hospitals performing endovascular repairs increased from 24 to 60. By 2002 there were more endovascular repairs being performed than open repairs (871 vs 783). The target population for these surgical interventions showed interesting differences. In 2002, women had a 43% chance of receiving an endograft, whereas men had a 55% probability. The use of endovascular repair over the observation period was relatively constant in patients younger than 65 years. In patients older than 65 years, and especially those older than 75 years, endovascular use increased substantially, so that by 2002 older patients were more likely to undergo endovascular repair than open repair. Patients who underwent endovascular repair had significantly more hypertension, coronary artery disease, diabetes, and hyperlipidemia than did patients who underwent open repair. Yet the mean length of stay for endovascular procedures was approximately 3.6 days, and for open procedures was about 10.3 days, across all 3 years (P = <.0001). Moreover, patients who underwent endovascular repair had statistically fewer postoperative complications and significantly lower mortality. In-hospital mortality in 2001 was 3.55% for open repair and 1.14% for endovascular repair (P =.0018), and in 2002 these rates were 4.21% versus 0.8% (P <.0001), respectively.
This dataset suggests that endovascular AAA repairs are being performed in a patient population with a higher frequency of comorbidities. However, endovascular repairs still are associated with significantly lower in-hospital mortality, fewer postoperative complications, and a dramatically shorter length of stay. These results suggest that, despite the rapid diffusion of this new technique, early perioperative outcomes may be superior to those with conventional open repair. However, prospective clinical studies are needed to confirm these insights, and such studies may require the infrastructure of consortia of hospitals or society-based registries.
本研究旨在比较纽约州腹主动脉瘤（AAA）血管内修复术与开放修复术的生存率及治疗结果。
我们使用纽约州出院数据集全州规划与研究合作系统（SPARCS），分析2000 - 2002年间非破裂性腹主动脉瘤（国际疾病分类第九版[ICD - 9] 441.4）开放动脉瘤修复术（38.44）和血管内动脉瘤修复术（39.71）的择期入院治疗结果。血管内修复术的ICD - 9编码于2000年末引入，因此获取了2000年3个月的经验数据。
纽约州进行的AAA手术数量显著增加（比较2000年前后：平均分别为1419例和1701例；P = 0.0001），这在时间上与美国食品药品监督管理局批准血管内移植物及新支付编码后实施的培训项目相吻合。从2000年到2002年，纽约州进行血管内修复术的医院数量从24家增加到60家。到2002年，进行血管内修复术的数量超过了开放修复术（871例对783例）。这些手术干预的目标人群存在有趣的差异。2002年，女性接受血管内移植物治疗的几率为43%，而男性为55%。在65岁以下的患者中，观察期内血管内修复术的使用相对稳定。在65岁以上的患者中，尤其是75岁以上的患者，血管内修复术的使用大幅增加，以至于到2002年，老年患者接受血管内修复术的可能性高于开放修复术。接受血管内修复术的患者比接受开放修复术的患者患有更多的高血压、冠状动脉疾病、糖尿病和高脂血症。然而，在这3年中，血管内手术的平均住院时间约为3.6天，开放手术约为10.3天（P = <0.0001）。此外，接受血管内修复术的患者术后并发症在统计学上更少，死亡率显著更低。2001年开放修复术的院内死亡率为3.55%，血管内修复术为1.14%（P = 0.0018），2002年这些比率分别为4.21%对0.8%（P <0.0001）。
该数据集表明，血管内AAA修复术正在合并症发生率较高的患者群体中进行。然而，血管内修复术仍与显著更低的院内死亡率、更少的术后并发症以及显著更短的住院时间相关。这些结果表明，尽管这项新技术迅速普及，但围手术期早期结果可能优于传统开放修复术。然而，需要前瞻性临床研究来证实这些观点，此类研究可能需要医院联合体或基于社会的登记系统的基础设施。
