Park Brian D, Azefor Nchang M, Huang Chun-Chih, Ricotta John J
The Washington Hospital Center, Georgetown University, Department of Surgery, Division of Vascular Surgery, Washington, DC.
The Washington Hospital Center, Georgetown University, Department of Surgery, Division of Vascular Surgery, Washington, DC.
Ann Vasc Surg. 2014 May;28(4):798-807. doi: 10.1016/j.avsg.2013.07.029. Epub 2013 Nov 1.
This study attempted to identify trends in the use of endovascular aneurysm repair (EVAR) and outcomes in elective abdominal aortic aneurysm (AAA) repair over a 5-year period in a nationwide dataset, with specific attention to patients older than 80 years.
The Nationwide Inpatient Sample database was queried for elective AAA repair during 2005 to 2009. Number of EVAR cases, ratio of EVAR/open aneurysm repair (OAR), major clinical outcomes, and discharge status were analyzed by decade. Interval data were compared with analysis of variance (ANOVA) and proportions via chi-squared tests.
A total of 174,714 AAA repairs (124,869 EVARs) were identified. The ratio of EVAR/OAR increased with increasing age. Between 2005 and 2009, the total number of AAA repairs increased by 21% (7,179 vs. 8,554) and EVARs increased by 50% (5,057 vs. 7,650; P < 0.05) in patients older than 80 years. In 2009, 85% of AAA repairs in patients older than 80 years were EVARs. Patients older than 80 years constituted 25% of the total EVAR cohort. Although the in-hospital mortality rate remained acceptable in all age groups, EVAR-associated mortality, length of stay, and discharge to a skilled nursing facility increased with each successive decade of life (P < 0.05). Rates of postoperative myocardial infarction and acute renal failure also increased with increasing age (P < 0.05). EVAR results are presented by decade.
EVAR is being performed with increasing frequency in patients older than 80 years, with one-quarter of EVAR performed in patients aged 80 years and older in the current sample. Although mortality rates remain acceptable in this elderly population, EVAR and OAR are associated with an age-dependent increase in death, complications, and discharge to extended care facilities. These factors, in addition to long-term risk of aneurysm rupture, should be considered when evaluating the appropriateness of elective aneurysm repair in the elderly.
本研究试图在一个全国性数据集中确定5年期间血管内动脉瘤修复术（EVAR）的使用趋势以及择期腹主动脉瘤（AAA）修复的结果，特别关注80岁以上的患者。
查询2005年至2009年期间全国住院患者样本数据库中择期AAA修复的情况。按十年分析EVAR病例数、EVAR/开放性动脉瘤修复术（OAR）的比例、主要临床结果及出院状态。区间数据通过方差分析（ANOVA）进行比较，比例通过卡方检验进行比较。
共识别出174,714例AAA修复术（124,869例EVAR）。EVAR/OAR的比例随年龄增长而增加。2005年至2009年期间，80岁以上患者的AAA修复总数增加了21%（7,179例对8,554例），EVAR增加了50%（5,057例对7,650例；P<0.05）。2009年，80岁以上患者中85%的AAA修复术为EVAR。80岁以上患者占EVAR总队列的25%。尽管所有年龄组的住院死亡率仍可接受，但与EVAR相关的死亡率、住院时间及转至专业护理机构的出院率随年龄每增加一个十年而增加（P<0.05）。术后心肌梗死和急性肾衰竭的发生率也随年龄增长而增加（P<0.05）。EVAR结果按十年呈现。
80岁以上患者接受EVAR的频率越来越高，在当前样本中，80岁及以上患者接受的EVAR占四分之一。尽管该老年人群的死亡率仍可接受，但EVAR和OAR与死亡、并发症及转至长期护理机构的年龄依赖性增加有关。在评估老年患者择期动脉瘤修复的适宜性时，除了动脉瘤破裂的长期风险外，还应考虑这些因素。
