St George's Vascular Institute, St George's University of London, London, UK.
Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.
Br J Surg. 2018 Apr;105(5):520-528. doi: 10.1002/bjs.10749. Epub 2018 Feb 22.
There is substantial international variation in mortality after abdominal aortic aneurysm (AAA) repair; many non-operative factors influence risk-adjusted outcomes. This study compared 90-day and 5-year mortality for patients undergoing elective AAA repair in England and Sweden.
Patients were identified from English Hospital Episode Statistics and the Swedish Vascular Registry between 2003 and 2012. Ninety-day mortality and 5-year survival were compared after adjustment for age and sex. Separate within-country analyses were performed to examine the impact of co-morbidity, hospital teaching status and hospital annual caseload.
The study included 36 249 patients who had AAA treatment in England, with a median age of 74 (i.q.r. 69-79) years, of whom 87·2 per cent were men. There were 7806 patients treated for AAA in Sweden, with a median of age 73 (68-78) years, of whom 82·9 per cent were men. Ninety-day mortality rates were poorer in England than in Sweden (5·0 versus 3·9 per cent respectively; P < 0·001), but were not significantly different after 2007. Five-year survival was poorer in England (70·5 versus 72·8 per cent; P < 0·001). Use of EVAR was initially lower in England, but surpassed that in Sweden after 2010. In both countries, poor outcome was associated with increased age. In England, institutions with higher operative annual volume had lower mortality rates.
Mortality for elective AAA repair was initially poorer in England than Sweden, but improved over time alongside greater uptake of EVAR, and now there is no difference. Centres performing a greater proportion of EVAR procedures achieved better results in England.
在腹主动脉瘤（AAA）修复后，死亡率存在很大的国际差异；许多非手术因素影响风险调整后的结果。本研究比较了在英国和瑞典接受择期 AAA 修复的患者的 90 天和 5 年死亡率。
患者于 2003 年至 2012 年期间在英国医院住院统计和瑞典血管登记处被识别出来。调整年龄和性别后，比较 90 天死亡率和 5 年生存率。在国内分别进行了分析，以研究合并症、医院教学地位和医院年手术量对结果的影响。
本研究纳入了 36249 名在英国接受 AAA 治疗的患者，其年龄中位数为 74（69-79）岁，其中 87.2%为男性。瑞典有 7806 名患者接受了 AAA 治疗，年龄中位数为 73（68-78）岁，其中 82.9%为男性。90 天死亡率在英国比瑞典差（分别为 5.0%和 3.9%；P<0.001），但在 2007 年后无显著差异。5 年生存率在英国较差（70.5%和 72.8%；P<0.001）。英国最初 EVAR 的使用率较低，但在 2010 年后超过了瑞典。在两国中，较差的结果都与年龄增加有关。在英国，手术年量较高的机构死亡率较低。
在接受择期 AAA 修复的患者中，英国的死亡率最初比瑞典差，但随着时间的推移，EVAR 的使用率增加，死亡率也有所下降，现在两国之间没有差异。在英国，进行更多 EVAR 手术的中心取得了更好的结果。
