Ohrlander T, Nessvi S, Gottsäter A, Dencker M, Acosta S
Department of Surgery, Eksjö County Hospital, Eksjö, Sweden.
Int Angiol. 2012 Aug;31(4):368-75.
The aim of this study was to compare preoperative patient evaluation by a vascular physician with a standardized workup protocol prior to elective endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA), in terms of differences in patient medication and mortality.
Consecutive patients with infrarenal AAA treated with standard EVAR from 1998 to 2006 (group 2) and 2007 to 2011 (group 1) were compared. Patients in group 1 (N.=201) were investigated preoperatively by a vascular physician, evaluating comorbidities and medication. Patients in group 2 (N.=304) underwent a standardized preoperative work-up including spirometry and echocardiography. Median time of follow-up was 23 months in group 1 and 71 months in group 2.
The proportion of patients who had on-going medication with anti-platelet and lipid lowering medication at admission was higher in group 1 compared to group 2 (62% versus 51%; P=0.013 and 68% versus 35%; P<0.001). In group 1, the proportion of newly instituted or increased dosage of anti-hypertensive, anti-platelet or lipid lowering medication at preoperative evaluation was 40%, 24% and 31%, respectively. The total cost for preoperative assessment per patient was 272 € in group 1 and 293 € in group 2 (P<0.001). There was no difference in 30-day (P=0.29) or long-term (P=0.24) mortality between the two groups.
Preoperative assessment by a vascular physician resulted in lower costs and improvement of medication against atherosclerosis, uncontrolled hypertension and perioperative ischemic cardiac events, but mortality was unaffected.
本研究旨在比较血管科医生在择期腹主动脉瘤腔内修复术（EVAR）治疗腹主动脉瘤（AAA）前，依据标准化检查方案进行的术前患者评估，在患者用药和死亡率方面的差异。
比较1998年至2006年（第2组）和2007年至2011年（第1组）接受标准EVAR治疗的连续性肾下腹主动脉瘤患者。第1组（N = 201）患者术前由血管科医生进行评估，评估合并症和用药情况。第2组（N = 304）患者接受包括肺活量测定和超声心动图在内的标准化术前检查。第1组的中位随访时间为23个月，第2组为71个月。
与第2组相比，第1组入院时正在使用抗血小板和降脂药物的患者比例更高（62%对51%；P = 0.013以及68%对35%；P < 0.001）。在第1组中，术前评估时新开始使用或增加剂量的抗高血压、抗血小板或降脂药物的比例分别为40%、24%和31%。第1组每位患者术前评估的总费用为272欧元，第2组为293欧元（P < 0.001）。两组之间30天（P = 0.29）或长期（P = 0.24）死亡率无差异。
血管科医生进行的术前评估可降低成本，并改善针对动脉粥样硬化、未控制的高血压和围手术期缺血性心脏事件的药物治疗，但死亡率未受影响。
