Behrendt Christian-Alexander, Sedrakyan Art, Rieß Henrik Christian, Heidemann Franziska, Kölbel Tilo, Petersen Jörg, Debus Eike Sebastian
Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Healthcare Policy and Research, Weill Cornell Medical College, New York, NY.
J Vasc Surg. 2017 Dec;66(6):1704-1711.e3. doi: 10.1016/j.jvs.2017.04.040. Epub 2017 Aug 7.
Endovascular aortic repair (EVAR) has emerged as a standard of care for abdominal aortic aneurysm (AAA) repair. However, real-world evidence to compare this technology to open aortic repair (OAR) is limited. Major gaps exist related to long-term outcomes of therapies worldwide.
Health insurance claims data of Germany's third largest insurance provider, DAK-Gesundheit, were used to determine outcomes after interventions for intact AAA (iAAA) and ruptured AAA (rAAA). The study included patients operated on between October 2008 and April 2015.
Included were 5509 patients (3627 EVAR and 1859 OAR). Median follow-up was 2.44 years (range, 0-6.46 years). The in-hospital mortality was lower after EVAR compared with OAR for both iAAA (1.2% vs 5.4%) and rAAA (26.1% vs 42%; P < .001). Postoperative length of stay and occurrence of complications were also lower after EVAR. The in-hospital mortality benefits of EVAR were most prominent in octogenarians (iAAA: EVAR, 2.2%; OAR, 18.2%; rAAA: EVAR, 34.4%; OAR, 62.3%; P < .001). However, the early survival benefit after EVAR reversed at ∼1.5 years, and Cox proportional hazard models revealed no differences in overall survival between EVAR and OAR. Landmark analysis focusing on patients surviving the procedure has shown lower survival in patients with EVAR.
In this largest European investigation to date using health insurance claims data, we found that in-hospital outcomes in Germany favor EVAR, which is comparable to findings reported in the United States and the United Kingdom. Trends toward lower long-term survival after EVAR after discharge are important and require future research and reflection.
血管内主动脉修复术（EVAR）已成为腹主动脉瘤（AAA）修复的标准治疗方法。然而，将该技术与开放主动脉修复术（OAR）进行比较的真实世界证据有限。全球范围内，治疗的长期结果存在重大差距。
使用德国第三大保险提供商DAK-Gesundheit的医疗保险理赔数据来确定完整AAA（iAAA）和破裂AAA（rAAA）干预后的结果。该研究纳入了2008年10月至2015年4月期间接受手术的患者。
纳入5509例患者（3627例行EVAR，1859例行OAR）。中位随访时间为2.44年（范围0至6.46年）。对于iAAA（1.2%对5.4%）和rAAA（26.1%对42%；P <.001），EVAR术后的住院死亡率均低于OAR。EVAR术后的住院时间和并发症发生率也较低。EVAR在住院死亡率方面的益处在八旬老人中最为显著（iAAA：EVAR为2.2%，OAR为18.2%；rAAA：EVAR为34.4%，OAR为62.3%；P <.001）。然而，EVAR术后的早期生存益处约在1.5年后逆转，Cox比例风险模型显示EVAR和OAR在总生存率上无差异。针对手术存活患者的标志性分析表明，接受EVAR的患者生存率较低。
在这项迄今为止欧洲最大的使用医疗保险理赔数据的调查中，我们发现德国的住院结局有利于EVAR，这与美国和英国报告的结果相当。出院后EVAR长期生存率较低的趋势很重要，需要未来进行研究和思考。
