Budtz-Lilly J, Venermo M, Debus S, Behrendt C-A, Altreuther M, Beiles B, Szeberin Z, Eldrup N, Danielsson G, Thomson I, Wigger P, Björck M, Loftus I, Mani K
Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.
Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland.
Eur J Vasc Endovasc Surg. 2017 Jul;54(1):13-20. doi: 10.1016/j.ejvs.2017.03.003. Epub 2017 Apr 13.
Case mix and outcomes of complex surgical procedures vary over time and between regions. This study analyses peri-operative mortality after intact abdominal aortic aneurysm (AAA) repair in 11 countries over 9 years.
Data on primary AAA repair from vascular surgery registries in 11 countries for the years 2005-2009 and 2010-2013 were analysed. Multivariate adjusted logistic regression analyses were carried out to adjust for variations in case mix.
A total of 83,253 patients were included. Over the two periods, the proportion of patients ≥80 years old increased (18.5% vs. 23.1%; p < .0001) as did the proportion of endovascular repair (EVAR) (44.3% vs. 60.6; p < .0001). In the latter period, 25.8% of AAAs were less than 5.5 cm. The mean annual volume of open repairs per centre decreased from 12.9 to 10.6 between the two periods (p < .0001), and it increased for EVAR from 10.0 to 17.1 (p < .0001). Overall, peri-operative mortality fell from 3.0% to 2.4% (p < .0001). Mortality for EVAR decreased from 1.5% to 1.1% (p < .0001), but the outcome worsened for open repair from 3.9% to 4.4% (p = .008). The peri-operative risk was greater for octogenarians (overall, 3.6% vs. 2.1%, p < .0001; open, 9.5% vs. 3.6%, p < .0001; EVAR, 1.8% vs. 0.7%, p < .0001), and women (overall, 3.8% vs. 2.2%, p < .0001; open, 6.0% vs. 4.0%, p < .0001; EVAR, 1.9% vs. 0.9%, p < .0001). Peri-operative mortality after repair of AAAs <5.5 cm was 4.4% with open repair and 1.0% with EVAR, p < .0001.
In this large international cohort, total peri-operative mortality continues to fall for the treatment of intact AAAs. The number of EVAR procedures now exceeds open procedures. Mortality after EVAR has decreased, but mortality for open operations has increased. The peri-operative mortality for small AAA treatment, particularly open surgical repair, is still considerable and should be weighed against the risk of rupture.
复杂外科手术的病例组合和结果会随时间以及地区的不同而变化。本研究分析了11个国家9年间完整腹主动脉瘤（AAA）修复术后的围手术期死亡率。
分析了11个国家血管外科登记处2005 - 2009年和2010 - 2013年原发性AAA修复的数据。进行多变量调整逻辑回归分析以调整病例组合的差异。
共纳入83253例患者。在这两个时期，≥80岁患者的比例增加（18.5%对23.1%；p <.0001），血管内修复（EVAR）的比例也增加（44.3%对60.6%；p <.0001）。在后一时期，25.8%的AAA直径小于5.5 cm。两个时期之间，每个中心开放修复的年均例数从12.9降至10.6（p <.0001），而EVAR的年均例数从10.0增至17.1（p <.0001）。总体而言，围手术期死亡率从3.0%降至2.4%（p <.0001）。EVAR的死亡率从1.5%降至1.1%（p <.0001），但开放修复的结果从3.9%恶化至4.4%（p =.008）。八旬老人的围手术期风险更高（总体上，3.6%对2.1%，p <.0001；开放手术，9.5%对3.6%，p <.0001；EVAR，1.8%对0.7%，p <.0001），女性也是如此（总体上，3.8%对2.2%，p <.0001；开放手术，6.0%对4.0%，p <.0001；EVAR，1.9%对0.9%，p <.0001）。直径<5.5 cm的AAA修复术后围手术期死亡率，开放修复为4.4%，EVAR为1.0%，p <.0001。
在这个大型国际队列中，完整AAA治疗的总围手术期死亡率持续下降。现在EVAR手术的数量超过了开放手术。EVAR术后死亡率有所下降，但开放手术的死亡率有所上升。小AAA治疗的围手术期死亡率，尤其是开放手术修复的死亡率仍然相当高，应权衡破裂风险。
