Trenner M, Haller B, Storck M, Reutersberg B, Kallmayer M A, Eckstein H-H
Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Institute for Medical Statistics and Epidemiology, Technical University of Munich, Munich, Germany.
Eur J Vasc Endovasc Surg. 2017 May;53(5):641-647. doi: 10.1016/j.ejvs.2016.12.024. Epub 2017 Jan 19.
OBJECTIVE/BACKGROUND: The study aim was to determine whether patient safety for non-ruptured abdominal aortic aneurysm (nrAAA) repair has changed between 1999 and 2010 in a large German cohort.
The data source was the prospective quality assurance registry of the German Vascular Society from 1999 to 2010. Patient characteristics, surgical techniques (open aortic repair [OAR], endovascular aortic repair [EVAR]), procedural time and outcomes, including the length of hospital stay (LOS), were analysed using the Cochran-Armitage test for binary parameters and Spearman's correlation coefficient for quantitative parameters.
A total of 36,594 operations (23,037 OAR, 13,557 EVAR) for infrarenal nrAAA in 201 hospitals in Germany were investigated. Patients' mean age increased from 69.6 to 72.0 years (p < .001). The rate of patients with American Society of Anesthesiologists scores of 3 or 4 increased (p < .001). Use of EVAR increased (1999: 16.7%; 2010: 62.7%; p < .001), and since 2009, EVAR has been more frequently used than OAR. The overall in hospital mortality decreased from 3.1% in 1999 to 2.3% in 2010 (p < .001). There were no temporal trends for mortality rates for EVAR (p = .233) or OAR (p = .281) when considered separately. Cardiac (1999: 8.1%; 2010: 5.1%; p < .001) and pulmonary (1999: 7.8%; 2010: 4.8%; p < .001) complications decreased. The rate of post-operative renal failure increased (1999: 3.6%; 2010 4.1%; p = .017), without increasing the rate of patients needing dialysis (1999: 1.7%; 2010: 1.7%; p = .171). The median LOS decreased from 17 days in 1999 to 10 days in 2010 (p < .001).
This study shows significantly improved post-procedural in hospital outcomes and decreased use of resources for nrAAA repair. This trend can probably be attributed to the implementation of EVAR as a standard technique, but some trends could also possibly be explained by a change in the remuneration system. The main limitation of the registry is the lack of internal and external validation. However, in hospital patient safety for AAA repair seems to have improved significantly in the participating hospitals.
目的/背景：本研究旨在确定1999年至2010年期间，德国一个大型队列中未破裂腹主动脉瘤（nrAAA）修复的患者安全性是否发生了变化。
数据来源为德国血管外科学会1999年至2010年的前瞻性质量保证登记处。使用Cochran-Armitage检验分析二元参数，使用Spearman相关系数分析定量参数，对患者特征、手术技术（开放主动脉修复术[OAR]、血管腔内主动脉修复术[EVAR]）、手术时间和结果（包括住院时间[LOS]）进行分析。
对德国201家医院的23,037例开放主动脉修复术和13,557例血管腔内主动脉修复术治疗肾下nrAAA的36,594例手术进行了调查。患者的平均年龄从69.6岁增至72.0岁（p <.001）。美国麻醉医师协会评分为3或4分的患者比例增加（p <.001）。血管腔内主动脉修复术的使用增加（1999年：16.7%；2010年：62.7%；p <.001），自2009年以来，血管腔内主动脉修复术的使用频率高于开放主动脉修复术。总体住院死亡率从1999年的3.1%降至2010年的2.3%（p <.001）。单独考虑时，血管腔内主动脉修复术（p =.233）或开放主动脉修复术（p =.281）的死亡率无时间趋势。心脏并发症（1999年：8.1%；2010年：5.1%；p <.001）和肺部并发症（1999年：7.8%；2010年：4.８%；p <.001）减少。术后肾衰竭发生率增加（1999年：3.6%；2010年：4.1%；p =.017），但需要透析的患者比例未增加（1999年：1.7%；2010年：1.7%；p =.171）。住院时间中位数从1999年的17天降至2010年的10天（p <.001）。
本研究表明，nrAAA修复术后的住院结局显著改善，资源使用减少。这种趋势可能归因于血管腔内主动脉修复术作为标准技术的应用，但也可能部分归因于薪酬制度的变化。登记处的主要局限性是缺乏内部和外部验证。然而，参与研究的医院中，AAA修复的住院患者安全性似乎有显著改善。
