Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
Eur J Vasc Endovasc Surg. 2019 Apr;57(4):488-498. doi: 10.1016/j.ejvs.2018.10.030. Epub 2019 Feb 7.
Hospital incidence, treatment modality, and in hospital mortality after surgery are reported for thoraco-abdominal aortic aneurysms (TAAAs) treated by endovascular or open means in Germany from 2005 to 2014.
Data were extracted from diagnosis related group statistics from the German Federal Statistical Office. All inpatient cases with a diagnosis of ruptured and non-ruptured TAAA (ICD-10 I71.5 and I71.6) and procedure codes for fenestrated or branched endovascular aortic repair (f/bEVAR 5-38a.7x and 5-38a.8x), open aortic repair (OAR 5-384.4), or hybrid procedure (5-384.b/c, 5-38a.a/b/8/80) were included. To adjust for sex, age, medical risk (Elixhauser comorbidity score), type of procedure, and type of admission, a multilevel multivariable regression model with robust error variance was applied. The primary outcome was in hospital mortality; secondary outcomes were organ complications. The relationship between annual hospital volume and outcome was analysed.
A total of 2607 cases (406 rTAAA, 2201 nrTAAA) were included. f/bEVAR was performed in 856 cases (32.8%), OAR in 1422 cases (54.5%), and hybrid repair in 354 cases (13.6%). Endovascular repair became more frequent over time (6% in 2005 vs. 76% in 2014 for nrTAAA). Hypertension (75.2%), peripheral artery disease (including abdominal aortic aneurysm, 49.5%), other heart diseases (44.6%), coronary heart disease (30.6%), and renal failure (28.7%) were the most frequently coded comorbidities. The number of hospitals treating TAAAs almost tripled within 9 years. The in hospital mortality was 46.1% for rTAAA and 15.9% for nrTAAA. f/bEVAR (RR 0.35, 0.24-0.51) and high hospital volume (p < .001) were significantly associated with decreased in hospital mortality. Aortic rupture, increasing age, and comorbidity were significantly associated with higher mortality (RR 3.17, 2.45-4.09; 1.52, 1.32-1.76, and 1.05, 1.04-1.06).
Seventy-six percent of all TAAAs were treated endovascularly in 2014 with increasing frequency over a decade. In hospital mortality is lower with endovascular repair and in high volume centres. Aortic rupture, age, and severe comorbidities are associated with worse outcomes.
报告 2005 年至 2014 年德国采用血管内或开放方式治疗胸腹主动脉瘤（TAAA）的住院发病率、治疗方式和住院死亡率。
从德国联邦统计局的诊断相关组统计数据中提取数据。所有诊断为破裂和未破裂 TAAA（ICD-10 I71.5 和 I71.6）的住院病例，以及血管内开窗或分支主动脉修复术（f/bEVAR 5-38a.7x 和 5-38a.8x）、开放主动脉修复术（OAR 5-384.4）或杂交手术（5-384.b/c、5-38a.a/b/8/80）的手术编码都被包括在内。为了调整性别、年龄、医疗风险（Elixhauser 合并症评分）、手术类型和入院类型，采用具有稳健误差方差的多层次多变量回归模型进行分析。主要结局是住院死亡率；次要结局是器官并发症。分析了年度医院容量与结局的关系。
共纳入 2607 例（406 例 rTAAA，2201 例 nrTAAA）。f/bEVAR 治疗 856 例（32.8%），OAR 治疗 1422 例（54.5%），杂交修复 354 例（13.6%）。随着时间的推移，血管内修复的应用越来越广泛（nrTAAA 从 2005 年的 6%增加到 2014 年的 76%）。高血压（75.2%）、外周动脉疾病（包括腹主动脉瘤，49.5%）、其他心脏病（44.6%）、冠心病（30.6%）和肾衰竭（28.7%）是最常编码的合并症。9 年内治疗 TAAA 的医院数量几乎增加了两倍。rTAAA 的住院死亡率为 46.1%，nrTAAA 的住院死亡率为 15.9%。f/bEVAR（RR 0.35，0.24-0.51）和高医院容量（p<.001）与降低住院死亡率显著相关。主动脉破裂、年龄增长和合并症与死亡率升高显著相关（RR 3.17，2.45-4.09；1.52，1.32-1.76，和 1.05，1.04-1.06）。
2014 年，76%的 TAAA 采用血管内治疗，十年来采用血管内治疗的比例不断增加。血管内修复和高容量中心的住院死亡率较低。主动脉破裂、年龄和严重合并症与预后不良相关。
