Rigberg David A, Zingmond David S, McGory Marcia L, 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):224-9. doi: 10.1016/j.jvs.2005.10.071.
The purpose of this study was to determine the in-hospital, 30-day, and 365-day mortality for the open repair of abdominal aortic aneurysms (AAAs), when stratified by age, in the general population. Age stratification could provide clinicians with information more applicable to an individual patient than overall mortality figures.
In a retrospective analysis, data were obtained from the California Office of Statewide Health Planning and Development (OSHPD) for the years 1995 to 1999. Out-of-hospital mortality was determined via linkage to the state death registry. All patients undergoing AAA repair as coded by International Classification of Diseases, 9th Revision (ICD-9) procedure code 38.44 and diagnosis codes 441.4 (intact) and 441.3/441.5 (ruptured) in California were identified. Patients <50 years of age were excluded. We determined in-hospital, 30-day, and 365-day mortality, and stratified our findings by patient age. Multivariate logistic regression was used to determine predictors of mortality in the intact and ruptured AAA cohorts.
We identified 12,406 patients (9,778 intact, 2,628 ruptured). Mean patient age was 72.4 +/- 7.2 years (intact) and 73.9 +/- 8.2 (ruptured). Men comprised 80.9% of patients, and 90.8% of patients were white. Overall, intact AAA patient mortality was 3.8% in-hospital, 4% at 30 days, and 8.5% at 365 days. There was a steep increase in mortality with increasing age, such that 365-day mortality increased from 2.9% for patients 51 to 60 years old to 15% for patients 81 to 90 years old. Mortality from day 31 to 365 was greater than both in-hospital and 30-day mortality for all but the youngest intact AAA patients. Perioperative (in-hospital and 30-day) mortality for ruptured cases was 45%, and mortality at 1 year was 54%.
There is continued mortality after the open repair of AAAs during postoperative days 31 to 365 that, for many patients, is greater than the perioperative death rate. This mortality increases dramatically with age for both intact and ruptured AAA repair.
本研究的目的是确定在普通人群中，按年龄分层时腹主动脉瘤（AAA）开放修复术后的住院死亡率、30天死亡率和365天死亡率。年龄分层可为临床医生提供比总体死亡率数据更适用于个体患者的信息。
在一项回顾性分析中，从加利福尼亚州全州卫生规划与发展办公室（OSHPD）获取了1995年至1999年的数据。通过与州死亡登记处的链接确定院外死亡率。识别出加利福尼亚州所有接受AAA修复的患者，其国际疾病分类第九版（ICD - 9）手术编码为38.44，诊断编码为441.4（完整型）和441.3/441.5（破裂型）。排除年龄小于50岁的患者。我们确定了住院死亡率、30天死亡率和365天死亡率，并按患者年龄对研究结果进行分层。使用多因素逻辑回归确定完整型和破裂型AAA队列中死亡率的预测因素。
我们识别出12406例患者（9778例完整型，2628例破裂型）。患者平均年龄为72.4±7.2岁（完整型）和73.9±8.2岁（破裂型）。男性占患者的80.9%，90.8%的患者为白人。总体而言，完整型AAA患者的住院死亡率为3.8%，30天死亡率为4%，365天死亡率为8.5%。随着年龄增长死亡率急剧上升，例如51至60岁患者的365天死亡率从2.9%增至81至90岁患者的15%。除最年轻的完整型AAA患者外，所有患者从第31天至365天的死亡率均高于住院死亡率和30天死亡率。破裂型病例的围手术期（住院和30天）死亡率为45%，1年死亡率为54%。
AAA开放修复术后第31天至365天存在持续的死亡率，对许多患者而言，该死亡率高于围手术期死亡率。完整型和破裂型AAA修复的死亡率均随年龄急剧增加。
