Harvard T.H. Chan School of Public Health, Boston, Mass.
Johns Hopkins Bayview Vascular and Endovascular Research Center, Baltimore, Md.
J Vasc Surg. 2019 Jan;69(1):64-73. doi: 10.1016/j.jvs.2018.04.032. Epub 2018 Jun 15.
Significant research efforts have been made to improve the safety and efficacy of endovascular aneurysm repair (EVAR) in treating abdominal aortic aneurysm. This study aimed to examine the trends of perioperative outcomes of EVAR in the recent decade using a national validated database.
Patients who underwent EVAR for intact abdominal aortic aneurysm between 2006 and 2015 were identified from the National Surgical Quality Improvement Program and divided into early (2006-2010) and late (2011-2015) periods. The primary outcome of the study was 30-day mortality. Secondary outcomes included operative time, length of hospital stay, and 30-day major complications (renal, cardiopulmonary, and wound infection).
A total of 30,076 patients were identified, with 11,539 in the early period and 18,537 in the late period. The 30-day mortality was kept at a low level in both periods (1.2% vs 1.2%; P = .98), whereas both the mean operation time (155.5 ± 72.6 minutes vs 141.9 ± 73.7 minutes; P < .001) and length of hospital stay (3.24 ± 5.32 days vs 2.81 ± 4.30 days; P < .001) were decreased in the late period. The 30-day major complication rate was reduced by 19.6% (5.1% vs 4.1%; P < .0001), with decreased renal failure (1.4% vs 1.0%; P = .003), cardiopulmonary complications (2.2% vs 1.7%; P = .006), and wound complications (2.5% vs 1.8%; P < .001). All the decreasing trends of mortality, any 30-day complication, and each type of major complication were statistically significant. Being treated in the late period was independently associated with decreased 30-day major complications (odds ratio, 0.75; 95% confidence interval, 0.65-0.87; P < .001), and this effect was confirmed in the propensity score-matched cohort (odds ratio, 0.76; 95% confidence interval, 0.66-0.90; P < .001).
Although the 30-day mortality remains similar, postoperative complications in EVAR have decreased significantly during the recent decade. The continuous improvement in endograft technology and surgical skills has resulted in decreased operative time, marked reduction in surgical complications, and shorter hospital length of stay after endovascular repair.
为了提高血管内动脉瘤修复术（EVAR）治疗腹主动脉瘤的安全性和疗效，已经进行了大量研究。本研究旨在使用国家验证数据库，研究最近十年 EVAR 围手术期结果的趋势。
从国家外科质量改进计划中确定了 2006 年至 2015 年间接受 EVAR 治疗的完整腹主动脉瘤患者，并将其分为早期（2006-2010 年）和晚期（2011-2015 年）。该研究的主要结果是 30 天死亡率。次要结果包括手术时间、住院时间和 30 天主要并发症（肾、心肺和伤口感染）。
共确定了 30766 名患者，其中早期有 11539 名，晚期有 18537 名。两个时期的 30 天死亡率均保持在较低水平（1.2%比 1.2%；P=.98），而手术时间（155.5±72.6 分钟比 141.9±73.7 分钟；P<.001）和住院时间（3.24±5.32 天比 2.81±4.30 天；P<.001）均有所缩短。晚期 30 天主要并发症发生率降低了 19.6%（5.1%比 4.1%；P<.0001），其中肾衰竭（1.4%比 1.0%；P=.003）、心肺并发症（2.2%比 1.7%；P=.006）和伤口并发症（2.5%比 1.8%；P<.001）均有所降低。死亡率、任何 30 天并发症和每种主要并发症的降低趋势均具有统计学意义。晚期治疗与 30 天主要并发症的降低独立相关（比值比，0.75；95%置信区间，0.65-0.87；P<.001），并且在倾向评分匹配队列中得到了证实（比值比，0.76；95%置信区间，0.66-0.90；P<.001）。
尽管 30 天死亡率保持相似，但最近十年 EVAR 的术后并发症显著减少。内支架技术和手术技能的不断改进，导致手术时间缩短，手术并发症明显减少，血管内修复后住院时间缩短。
