Rigberg David A, McGory Marcia L, Zingmond David S, Maggard Melinda A, Agustin Michelle, Lawrence Peter F, Ko Clifford Y
Center for Surgical Outcomes and Quality, UCLA School of Medicine, West Los Angeles Veterans' Administration Medical Center, Los Angeles, CA, USA.
J Vasc Surg. 2006 Feb;43(2):217-22; discussion 223. doi: 10.1016/j.jvs.2005.10.070.
The purpose of this study was to determine the 30-day and 365-day mortality for the repair of thoracoabdominal aortic aneurysms (TAA), when stratified by age, in the general population. These data provide clinicians with information more applicable to an individual patient than mortality figures from a single institutional series.
Data were obtained from the California Office of Statewide Health Planning and Development (OSHPD) for the years 1991 to 2002. These data were linked to the state death certificate file, allowing for continued information on the status of the patients after hospital discharge. All patients undergoing elective and ruptured TAA repair as coded by International Classification of Diseases, 9th Clinical Modification (ICD-9, CM) in California were identified. Patients aged <50 or >90 years old were excluded. We determined 30- and 365-day mortality and stratified our findings by decade of patient age (eg, 50 to 59). Demographics of elective and ruptured cases were also compared.
We identified 1010 patients (797 elective, 213 ruptured) who underwent TAA repair. Mean patient ages were 70.0 (elective) and 72.1 years (ruptured). Men comprised 62% of elective and 68% of ruptured aneurysm patients, and 80% (elective) and 74% (ruptured) were white. Overall elective patient mortality was 19% at 30 days and 31% at 365 days. There was a steep increase in mortality with increasing age, such that elective 365-day mortality increased from about 18% for patients 50 to 59 years old to 40% for patients 80 to 89 years old. The elective case 31-day to 365-day mortality ranged from 7.8% for the youngest patients to 13.5%. Mortality for ruptured cases was 48.4% at 30 days and 61.5% at 365 days, and these rates also increased with age.
Our observed 30-day mortality for TAA repairs is consistent with previous reports; however, mortality at 1 year demonstrates a significant risk beyond the initial perioperative period, and this risk increases with age. These data reflect surgical mortality for TAA repair in the general population and may provide more useful data for surgeons and patients contemplating TAA surgery.
本研究的目的是确定在一般人群中，按年龄分层的胸腹主动脉瘤（TAA）修复术后30天和365天的死亡率。这些数据为临床医生提供了比单一机构系列的死亡率数据更适用于个体患者的信息。
数据来自加利福尼亚州全州卫生规划与发展办公室（OSHPD）1991年至2002年的记录。这些数据与该州的死亡证明文件相关联，以便在患者出院后继续了解其状况。识别出加利福尼亚州所有按照国际疾病分类第九版临床修订本（ICD-9，CM）编码进行择期和破裂性TAA修复的患者。排除年龄小于50岁或大于90岁的患者。我们确定了30天和365天的死亡率，并按患者年龄的十年分层（例如，50至59岁）。还比较了择期和破裂病例的人口统计学特征。
我们识别出1010例接受TAA修复的患者（797例择期手术，213例破裂性手术）。择期手术患者的平均年龄为70.0岁，破裂性手术患者为72.1岁。男性占择期动脉瘤患者的62%，破裂性动脉瘤患者的68%，80%（择期）和74%（破裂性）为白人。择期手术患者的总体30天死亡率为19%，365天死亡率为31%。随着年龄的增加，死亡率急剧上升，因此择期手术患者的365天死亡率从50至59岁患者的约18%增加到80至89岁患者的40%。择期手术病例从31天到365天的死亡率从最年轻患者的7.8%到13.5%不等。破裂性病例的30天死亡率为48.4%，365天死亡率为61.5%，这些比率也随年龄增加。
我们观察到的TAA修复术后30天死亡率与先前的报告一致；然而，1年时的死亡率表明在初始围手术期之后存在重大风险，并且这种风险随年龄增加。这些数据反映了一般人群中TAA修复的手术死亡率，可能为考虑进行TAA手术的外科医生和患者提供更有用的数据。
