Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Alabama; Birmingham VA Medical Center, Birmingham, Alabama.
Birmingham VA Medical Center, Birmingham, Alabama; Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama.
J Surg Res. 2022 Nov;279:383-392. doi: 10.1016/j.jss.2022.06.005. Epub 2022 Jul 9.
Clinical trials at the advent of endovascular aortic aneurysm repairs (EVARs) demonstrated improved early survival with EVAR compared to open repairs; however, characterizations of routine contemporary care have been limited. This study compares postoperative survival among Veterans in clinical care following abdominal aortic aneurysm (AAA) repair with EVAR versus open repairs since the widespread adoption of EVAR.
This retrospective cohort analysis of Veterans with AAA repairs from 2007 to 2020 at Veterans Affairs (VA) facilities evaluated survival by a repair method. Administrative International Classification of Diseases 9/10 codes and sociodemographic characteristics from structured charting were used for characterization and adjusted analyses. Demographics were compared via Chi-squared and Wilcoxon rank-sum testing and mortality evaluated using Kaplan-Meier and Cox proportional hazard analyses.
Among 15,480 AAA repairs (3566 open, and 11,914 EVAR), patients receiving open repairs were younger with lower Charlson scores compared to EVARs. EVAR was associated with better survival until 2.4 y post-procedure. Mean long-term survival, however, was higher for open surgery (6.3 ± 3.8 versus 5.8 ± 3.1 y in EVAR). After adjustment for gender, race, and ethnicity, EVAR was associated with worse survival (mortality hazard ratio [HR] 1.17; 95% confidence interval [CI], 1.11-1.24) as was each increment in Charlson score (HR 1.11; CI 1.10-1.12), whereas service-connected care (HR 0.73; CI, 0.70-0.77) and age (HR 0.99; CI, 0.98-0.99) were associated with better survival.
In contemporary Veteran aneurysm repairs, although a higher early survival rate was observed in EVAR repairs, long-term survival was higher for open repairs. Service-connected care was independently associated with greater survival after aneurysm repair.
在血管内主动脉瘤修复术（EVAR）问世之初的临床试验中，与开放修复相比，EVAR 可提高早期生存率；然而，对常规当代治疗的描述一直有限。本研究比较了 EVAR 广泛应用后，退伍军人在临床护理中接受腹主动脉瘤（AAA）修复后的术后生存情况，与开放修复相比。
这项对退伍军人 AAA 修复的回顾性队列分析，时间从 2007 年到 2020 年在退伍军人事务部（VA）的设施中进行，评估了通过修复方法的生存情况。使用行政国际疾病分类第 9/10 代码和结构化图表的社会人口统计学特征进行特征描述和调整分析。通过卡方检验和 Wilcoxon 秩和检验比较人口统计学数据，使用 Kaplan-Meier 和 Cox 比例风险分析评估死亡率。
在 15480 例 AAA 修复中（3566 例开放修复，11914 例 EVAR），接受开放修复的患者比 EVAR 患者年龄更小，Charlson 评分更低。EVAR 与术后 2.4 年内更好的生存相关。然而，长期平均生存率，开放手术更高（6.3±3.8 年 vs EVAR 为 5.8±3.1 年）。在调整性别、种族和民族后，EVAR 与较差的生存相关（死亡率风险比 [HR] 1.17；95%置信区间 [CI]，1.11-1.24），Charlson 评分每增加 1 分（HR 1.11；CI 1.10-1.12）也是如此，而服务连接护理（HR 0.73；CI 0.70-0.77）和年龄（HR 0.99；CI 0.98-0.99）与更好的生存相关。
在当代退伍军人动脉瘤修复中，尽管 EVAR 修复的早期生存率较高，但开放修复的长期生存率更高。服务连接护理与动脉瘤修复后生存的改善独立相关。
