Department of Surgery, State University of New York, Downstate Health Sciences University, Brooklyn, NY.
College of Nursing, State University of New York, Downstate Health Sciences University, Brooklyn, NY.
J Vasc Surg. 2024 Nov;80(5):1448-1454.e1. doi: 10.1016/j.jvs.2024.07.022. Epub 2024 Jul 11.
Observational studies demonstrate reduced mortality after endovascular (EVAR) compared with open aneurysm repair (OAR) for ruptured abdominal aortic aneurysms (rAAAs). We sought to determine national trends in repair type and in-hospital mortality rates for rAAAs.
We analyzed patients with rAAAs managed with OAR or EVAR from 2002 to 2020 in the National Inpatient Sample and evaluated annual trends in volume and in-hospital mortality by repair type. Multilevel mixed effects logistic regression model was fit for patient and system-level risk adjustment. We assessed interactions between time, sex, and Elixhauser index with repair type.
We examined 13,376 patients with rAAAs. Of these, 8357 (62.5%) underwent OAR. Patients receiving EVAR were slightly older (73.7 vs 72.5 years; P < .001) with slightly higher mean Elixhauser index (4.0 vs 3.8; P < .001). Unadjusted in-hospital mortality was 37.4% vs 22.4% for OAR and EVAR, respectively. EVAR offered a risk-adjusted survival advantage (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.32-0.46). There was a statistically significant reduction of in-hospital mortality over time in the EVAR group (interaction OR, 0.96; 95% CI, 0.95-0.98). The interaction between Elixhauser index and repair was not statistically significant (interaction OR, 0.95; 95% CI, 0.87-1.05).
Survival rates for OAR and EVAR improved over time. EVAR persistently provided a substantial survival advantage over OAR in patients with rAAAs over the past 2 decades.
观察性研究表明，与开放型腹主动脉瘤修复术（OAR）相比，血管内修复术（EVAR）治疗破裂性腹主动脉瘤（rAAA）可降低死亡率。我们旨在确定 rAAA 修复类型和住院死亡率的全国趋势。
我们分析了 2002 年至 2020 年期间在国家住院患者样本中接受 OAR 或 EVAR 治疗的 rAAA 患者，并评估了按修复类型划分的每年的容量和住院死亡率趋势。采用多水平混合效应逻辑回归模型对患者和系统水平的风险进行调整。我们评估了时间、性别和 Elixhauser 指数与修复类型之间的相互作用。
我们共检查了 13376 例 rAAA 患者。其中 8357 例（62.5%）接受了 OAR。接受 EVAR 的患者年龄稍大（73.7 岁比 72.5 岁；P<0.001），平均 Elixhauser 指数稍高（4.0 比 3.8；P<0.001）。未调整的住院死亡率分别为 OAR 和 EVAR 组的 37.4%和 22.4%。EVAR 提供了风险调整后的生存优势（比值比 [OR]，0.39；95%置信区间 [CI]，0.32-0.46）。EVAR 组的住院死亡率随时间呈统计学显著下降（交互 OR，0.96；95% CI，0.95-0.98）。Elixhauser 指数与修复之间的交互作用无统计学意义（交互 OR，0.95；95% CI，0.87-1.05）。
随着时间的推移，OAR 和 EVAR 的生存率有所提高。在过去的 20 年中，EVAR 持续为 rAAA 患者提供了优于 OAR 的显著生存优势。
