编辑精选 - 2010 年至 2016 年国际血管登记研究协会分析各国腹主动脉瘤修复结果的差异。
Editor's Choice - Variation in Intact Abdominal Aortic Aneurysm Repair Outcomes by Country: Analysis of International Consortium of Vascular Registries 2010 - 2016.
机构信息
Cambridge Vascular Unit, Cambridge University Hospitals NHS Trust & Department of Surgery, University of Cambridge, Cambridge, UK.
Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.
出版信息
Eur J Vasc Endovasc Surg. 2021 Jul;62(1):16-24. doi: 10.1016/j.ejvs.2021.03.034. Epub 2021 Jun 16.
OBJECTIVE
Outcomes for intact abdominal aortic aneurysm (AAA) repair vary over time and by healthcare system, country, and surgeon. The aim of this study was to analyse peri-operative mortality for intact AAA repair in 11 countries over time and compare outcomes by gender, age, and geographical location.
METHODS
Prospective data on primary repair of intact AAA were collected from 11 countries through the International Consortium of Vascular Registries (ICVR) and analysed for two time periods, 2010 - 2013 and 2014 - 2016. The primary outcome was peri-operative mortality after endovascular aneurysm repair (EVAR) and open surgical repair (OSR). Multivariable logistic regression models were used to adjust for differences in patient characteristics.
RESULTS
A total of 103 715 patients were included. The percentage of patients undergoing EVAR increased from 63.6% to 71.2% (p < .001) over the study period. This proportion varied by country from 35% in Hungary to 81% in the United States. Overall peri-operative mortality decreased from 2.1% to 1.6 % (p < .001). Mortality also declined significantly over time for both OSR 4.2% to 3.6 % (p = .002) and EVAR 1.0% to 0.7% (p = .002). Mortality was significantly higher for female than male patients (3.0% vs. 1.6% p < .001). The percentage of patients > 80 years old undergoing AAA repair remained constant at 23.6% (p = .91). Peri-operative mortality was higher for patients > 80 years than for those < 80 years old (2.7% vs. 1.6% p < .001). Forty-six per cent (n = 275) of all EVAR deaths occurred in the over 80s.
CONCLUSION
The proportion of AAA repairs performed using EVAR has increased over time. Peri-operative mortality continues to decline for both OSR and EVAR. Outcomes however were significantly worse for both women and those aged over 80, so efforts should be focused on these patient groups to further reduce elective AAA mortality rates.
目的
完整腹主动脉瘤（AAA）修复的结果随时间和医疗保健系统、国家以及外科医生而变化。本研究的目的是分析 11 个国家在一段时间内完整 AAA 修复的围手术期死亡率，并按性别、年龄和地理位置比较结果。
方法
通过国际血管登记处联合会（ICVR）从 11 个国家前瞻性收集完整 AAA 初次修复的数据，并分析了两个时间段，即 2010 年至 2013 年和 2014 年至 2016 年。主要结果是血管内动脉瘤修复（EVAR）和开放手术修复（OSR）后的围手术期死亡率。多变量逻辑回归模型用于调整患者特征的差异。
结果
共纳入 103715 例患者。EVAR 患者的比例从研究期间的 63.6%增加到 71.2%（p<0.001）。这一比例因国家而异，从匈牙利的 35%到美国的 81%不等。总体围手术期死亡率从 2.1%降至 1.6%（p<0.001）。OSR 从 4.2%降至 3.6%（p=0.002），EVAR 从 1.0%降至 0.7%（p=0.002），死亡率也随时间显著下降。女性患者的死亡率明显高于男性患者（3.0%比 1.6%，p<0.001）。接受 AAA 修复的>80 岁患者的比例保持在 23.6%（p=0.91）。>80 岁患者的围手术期死亡率高于<80 岁患者（2.7%比 1.6%，p<0.001）。所有 EVAR 死亡中，46%（n=275）发生在>80 岁患者中。
结论
随着时间的推移，EVAR 进行的 AAA 修复比例增加。OSR 和 EVAR 的围手术期死亡率持续下降。然而，女性和>80 岁患者的结果明显更差，因此应将重点放在这些患者群体上，以进一步降低择期 AAA 的死亡率。
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