Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departament de Cirurgia, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain.
Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Eur J Vasc Endovasc Surg. 2024 Jul;68(1):30-38. doi: 10.1016/j.ejvs.2024.02.034. Epub 2024 Feb 29.
Registry data suggest that centralising abdominal aortic aneurysm (AAA) surgery decreases the mortality rate after AAA repair. However, the impact of higher elective volumes on ruptured AAA (rAAA) repair associated mortality rates remains uncertain. This study aimed to examine associations between intact AAA (iAAA) repair volume and post-operative rAAA death.
Using data from official national registries between 2015 - 2019, all iAAA and rAAA repairs were separately analysed across 10 public hospitals. The following were assessed: 30 day and 12 month mortality rate following open surgical repair (OSR) and endovascular aneurysm repair (EVAR). Associations between the 5 year hospital iAAA repair volumes (organised into tertiles) and rAAA associated mortality rate were analysed, regardless of treatment modality. Receiver operating characteristic (ROC) curves were generated to identify iAAA volume thresholds for decreasing the rAAA mortality rate. Subanalysis by treatment type was conducted. Threshold analysis was repeated with the Markov chain Monte Carlo (MCMC) procedure to confirm the findings.
A total of 1 599 iAAAs (80.2% EVAR, 19.8% OSR) and 196 rAAAs (66.3% EVAR, 33.7% OSR) repairs were analysed. The median and interquartile range of the volume/hospital/year for all iAAA repairs were 39.2 (31.2, 47.4). The top volume iAAA tertile exhibited lower rAAA associated 30 day (odds ratio [OR] 0.374; p = .007) and 12 month (OR 0.264; p < .001) mortality rates. The ROC analysis revealed a threshold of 40 iAAA repairs/hospital/year (EVAR + OSR) for a reduced rAAA mortality rate. Middle volume hospitals for open iAAA repair had reduced 30 day (OR 0.267; p = .033) and 12 month (OR 0.223; p = .020) mortality rates, with a threshold of five OSR procedures/year. The MCMC procedure found similar thresholds. No significant association was found between elective EVAR volumes and ruptured EVAR mortality.
Higher iAAA repair volumes correlated with a lower rAAA mortality rate, particularly for OSR. The recommended iAAA repair threshold is 40 procedures/year and five procedures/year for OSR. These findings support high elective volumes for improving the rAAA mortality rate, especially for OSR.
注册数据表明，集中进行腹主动脉瘤（AAA）手术可降低 AAA 修复后的死亡率。然而，较高的择期手术量对破裂性 AAA（rAAA）修复相关死亡率的影响仍不确定。本研究旨在研究完整 AAA（iAAA）修复量与术后 rAAA 死亡之间的关系。
使用 2015 年至 2019 年官方国家登记处的数据，在 10 家公立医院中分别对所有 iAAA 和 rAAA 修复进行分析。评估内容包括开放手术修复（OSR）和血管内动脉瘤修复（EVAR）后 30 天和 12 个月的死亡率。分析了 5 年医院 iAAA 修复量（分为三部分）与 rAAA 相关死亡率之间的关系，而不考虑治疗方式。生成接收者操作特征（ROC）曲线，以确定降低 rAAA 死亡率的 iAAA 体积阈值。对不同治疗类型进行了亚组分析。使用马尔可夫链蒙特卡罗（MCMC）程序进行了阈值分析，以确认研究结果。
共分析了 1599 例 iAAA（80.2%EVAR，19.8%OSR）和 196 例 rAAA（66.3%EVAR，33.7%OSR）修复。所有 iAAA 修复的中位数和四分位距为 39.2（31.2，47.4）/医院/年。iAAA 顶级体积三分位数的 30 天（比值比 [OR]0.374；p=0.007）和 12 个月（OR0.264；p<0.001）死亡率均较低。ROC 分析显示，EVAR+OSR 的 iAAA 修复量为 40 个/医院/年是降低 rAAA 死亡率的阈值。开放性 iAAA 修复的中等容量医院的 30 天（OR0.267；p=0.033）和 12 个月（OR0.223；p=0.020）死亡率降低，阈值为每年 5 次 OSR 手术。MCMC 程序发现了类似的阈值。择期 EVAR 量与破裂性 EVAR 死亡率之间无显著相关性。
较高的 iAAA 修复量与 rAAA 死亡率降低相关，尤其是 OSR。推荐的 iAAA 修复阈值为每年 40 例，OSR 每年 5 例。这些发现支持高选择性手术量可改善 rAAA 死亡率，特别是 OSR。
