2000 年至 2010 年美国主动脉瘤修复的流行病学研究。
Epidemiology of aortic aneurysm repair in the United States from 2000 to 2010.
机构信息
Center for Translational Injury Research (CeTIR), Department of Surgery, University of Texas-Houston, Houston, Tex; Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisc.
Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisc.
出版信息
J Vasc Surg. 2014 Jun;59(6):1512-7. doi: 10.1016/j.jvs.2014.01.007. Epub 2014 Feb 20.
OBJECTIVE
Broad application of endovascular aneurysm repair (EVAR) has led to a rapid decline in open aneurysm repair (OAR) and improved patient survival, albeit at a higher overall cost of care. The aim of this report is to evaluate national trends in the incidence of unruptured and ruptured abdominal aortic aneurysms (AAAs), their management by EVAR and OAR, and to compare overall patient characteristics and clinical outcomes between these two approaches.
METHODS
A retrospective analysis of the cross-sectional National Inpatient Sample (2000-2010) was used to evaluate patient characteristics and outcomes related to EVAR and OAR for unruptured and ruptured AAAs. Data were extrapolated to represent population-level statistics through the use of data from the U.S. Census Bureau. Comparisons between groups were made with the use of descriptive statistics.
RESULTS
There were 101,978 patients in the National Inpatient Sample affected by AAAs over the 11-year span of this study; the average age was 73 years, 21% were women, and 90% were white. Overall in-hospital mortality rate was 7%, with a median length of stay (LOS) of 5 days and median hospital charges of $58,305. In-hospital mortality rate was 13 times greater for ruptured patients, with a median LOS of 9 days and median charges of $84,744. For both unruptured and ruptured patients, EVAR was associated with a lower in-hospital mortality rate (4% vs 1% for unruptured and 41% vs 27% for ruptured; P < .001 for each), shorter median LOS (7 vs 2; 9 vs 6; P < .001) but a 27%-36% increase in hospital charges.
CONCLUSIONS
The overall use of EVAR has risen sharply in the past 10 years (5.2% to 74% of the total number of AAA repairs) even though the total number of AAAs remains stable at 45,000 cases per year. In-hospital mortality rates for both ruptured and unruptured cases have fallen by more than 50% during this time period. Lower mortality rates and shorter LOS despite a 27%-36% higher cost of care continues to justify the use of EVAR over OAR. For patients with suitable anatomy, EVAR should be the preferred management of both ruptured and unruptured AAAs.
目的
血管内动脉瘤修复术（EVAR）的广泛应用导致开放型动脉瘤修复术（OAR）迅速减少，患者生存率提高，尽管整体护理成本更高。本报告的目的是评估未破裂和破裂性腹主动脉瘤（AAA）的发病率、EVAR 和 OAR 的治疗情况，并比较这两种方法的患者总体特征和临床结局。
方法
使用回顾性分析的横断面全国住院患者样本（2000-2010 年）来评估 EVAR 和 OAR 治疗未破裂和破裂性 AAA 的患者特征和结局。通过使用美国人口普查局的数据推断这些数据代表人群统计学。使用描述性统计比较组间差异。
结果
在这项研究的 11 年期间，全国住院患者样本中有 101978 例患者患有 AAA；平均年龄为 73 岁，21%为女性，90%为白人。总体院内死亡率为 7%，中位住院时间（LOS）为 5 天，中位住院费用为 58305 美元。破裂性患者的院内死亡率高 13 倍，中位 LOS 为 9 天，中位费用为 84744 美元。对于未破裂和破裂性患者，EVAR 与较低的院内死亡率相关（未破裂患者为 4%，破裂患者为 1%；破裂患者为 41%，破裂患者为 27%；均<0.001），中位 LOS 较短（未破裂患者为 7 天，破裂患者为 2 天；未破裂患者为 9 天，破裂患者为 6 天；均<0.001），但住院费用增加了 27%-36%。
结论
尽管每年的 AAA 病例数保持在 45000 例不变，但过去 10 年 EVAR 的总体使用率急剧上升（从总 AAA 修复数的 5.2%上升到 74%）。在此期间，破裂性和未破裂性病例的院内死亡率均下降了 50%以上。尽管成本增加了 27%-36%，但死亡率和 LOS 较低仍证明 EVAR 优于 OAR。对于具有合适解剖结构的患者，EVAR 应作为破裂性和未破裂性 AAA 的首选治疗方法。
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