Vogel Todd R, Dombrovskiy Viktor Y, Graham Alan M
Division of Vascular Surgery, The Surgical Outcomes Research Group, Robert Wood Johnson Medical School, One Robert Wood Johnson Place, New Brunswick, NJ 08903-0019, USA.
J Am Coll Surg. 2009 Sep;209(3):356-63. doi: 10.1016/j.jamcollsurg.2009.05.024. Epub 2009 Jul 24.
There has been a dramatic increase in the use of endovascular technology for treatment of abdominal aortic aneurysms (AAA), but practice patterns have not been well-evaluated. Hospital resource use and outcomes after elective endovascular abdominal aortic repair (EVAR) and open surgical repair were assessed by hospital type, ie, major teaching (MT), teaching affiliate, and nonteaching (NT).
Elective, nonruptured AAA repairs were identified in the State Inpatient Databases for New Jersey (2001 to 2006). Descriptive statistics, univariate, multivariable, trend, and case-mix-adjustment analyses were employed.
A total of 6,227 subjects were identified; 4,698 patients (mean age 73.0 +/- 8.01 years; 79.2% men) underwent elective repair of AAA. EVAR was performed 2.6 times more often in MT compared with NT (p < 0.0001) institutions. Univariate evaluation demonstrated that women had a predominance of EVAR performed (p < 0 .0002) in MT hospitals and that minorities in NT hospitals were more likely to be treated with open operations (p = 0.0148). Case-mix-adjusted mortality rates for EVAR were higher at NT (1.95%; 95% CI, 1.81 to 2.09) compared with MT (0.73%; 95% CI, 0.69 to 0.77) hospitals. After adjustment, MT hospitals were more likely to use EVAR (odds ratio = 2.4; 95% CI, 2.11 to 2.83) and less likely to have increased length of stay (odds ratio = 0.38; 95% CI, 0.32 to 0.44) compared with NT.
Hospital teaching status was significantly associated with repair type, overall mortality, and hospital resource use. MT hospitals were considerably more likely to use EVAR for elective AAA repair, offered an improvement in survival, were more likely to treat women and minorities with EVAR, and demonstrated decreased length of stay and cost.
血管内技术在腹主动脉瘤（AAA）治疗中的应用急剧增加，但实践模式尚未得到充分评估。通过医院类型，即大型教学医院（MT）、教学附属医院和非教学医院（NT），评估了择期血管内腹主动脉修复术（EVAR）和开放手术修复后的医院资源使用情况及治疗结果。
在新泽西州住院患者数据库中识别出择期、未破裂的AAA修复病例（时间范围为2001年至2006年）。采用描述性统计、单变量、多变量、趋势分析和病例组合调整分析。
共识别出6227例受试者；4698例患者（平均年龄73.0±8.01岁；79.2%为男性）接受了AAA择期修复。与NT机构相比，MT机构进行EVAR的频率高2.6倍（p<0.0001）。单变量评估表明，在MT医院，接受EVAR治疗的女性占多数（p<0.0002），而在NT医院，少数族裔更有可能接受开放手术治疗（p = 0.0148）。与MT医院（0.73%；95%CI，0.69至0.77）相比，NT医院EVAR的病例组合调整死亡率更高（1.95%；95%CI，1.81至2.09）。调整后，与NT医院相比，MT医院更有可能使用EVAR（优势比=2.4；95%CI，2.11至2.83），住院时间延长的可能性更小（优势比=0.38；95%CI，0.32至0.44）。
医院教学状况与修复类型、总体死亡率和医院资源使用显著相关。MT医院在AAA择期修复中使用EVAR的可能性要大得多，生存率有所提高，用EVAR治疗女性和少数族裔的可能性更大，且住院时间缩短、成本降低。
