Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine and ASST Settelaghi University Teaching Hospital, Varese, Italy.
Anesthesia and Palliative Care, ASST Settelaghi University Teaching Hospital, Varese, Italy.
Eur J Cardiothorac Surg. 2024 Sep 2;66(3). doi: 10.1093/ejcts/ezae319.
To analyze how the experience of the surgical team went to impact the outcomes after open surgical repair (OSR) of intact abdominal aortic aneurysms (AAAs).
This is a single-center, observational cohort study with retrospective analysis of all OR for intact AAA performed between 1 January 2010 and 31 December 2022. The primary outcome was survival at 30 days and in follow-up, and a composite outcome of mortality and major complication. The secondary outcome was freedom from aorta-related reintervention. All outcomes were stratified according to the experience of the operating team (surgeons and anesthesiology).
We analyzed 103 (7.2%) patients: 97 (94.2%) males and 6 (5.8%) females. The mean age was 76 ± 8 years (range, 55-93). The best possible team composition was present in 52 (50.5%) interventions. The follow-up index was 0.82 ± 0.18 (range, 0.6-1.0). Mean follow-up duration was 59 ± 43 months (range, 0-158). We observed no differences between teams in major complications (best, 17.3% vs mixed, 21.6%; OR: 0.4, P = 0.622), 30 days mortality (best, 0% vs mixed, 5.9%; OR: 7.6, P = 0.118) and composite outcome (best, 11.5% vs mixed, 17.6%; OR: 0.8, P = 0.416). Cox regression analysis identified the best possible team as a protective factor against the need for reintervention (hazard ratio: 0.2; 95% confidence interval: 0.06-0.88, P = 0.032).
In our experience, OR of AAA yielded satisfactory results in terms of safety and efficacy independently of the team's experience. A more experienced team may protect against aorta-related reintervention.
分析手术团队的经验如何影响开放手术修复（OSR）完整腹主动脉瘤（AAA）后的结果。
这是一项单中心、观察性队列研究，对 2010 年 1 月 1 日至 2022 年 12 月 31 日期间所有接受完整 AAA 开放手术的 OR 进行回顾性分析。主要结局是 30 天和随访时的生存率，以及死亡和主要并发症的复合结局。次要结局是免于主动脉相关再介入。所有结局均根据手术团队（外科医生和麻醉师）的经验进行分层。
我们分析了 103 例（7.2%）患者：97 例（94.2%）为男性，6 例（5.8%）为女性。平均年龄为 76±8 岁（范围，55-93 岁）。最佳团队组成出现在 52 次干预中（50.5%）。随访指数为 0.82±0.18（范围，0.6-1.0）。平均随访时间为 59±43 个月（范围，0-158 个月）。我们没有观察到团队之间在主要并发症（最佳组 17.3%，混合组 21.6%；OR：0.4，P=0.622）、30 天死亡率（最佳组 0%，混合组 5.9%；OR：7.6，P=0.118）和复合结局（最佳组 11.5%，混合组 17.6%；OR：0.8，P=0.416）方面存在差异。Cox 回归分析确定最佳团队是免于再介入的保护因素（风险比：0.2；95%置信区间：0.06-0.88，P=0.032）。
根据我们的经验，AAA 的 OR 在安全性和疗效方面取得了令人满意的结果，与团队的经验无关。更有经验的团队可能有助于预防主动脉相关的再介入。
