Umegaki Takeshi, Kunisawa Susumu, Kamibayashi Takahiko, Fushimi Kiyohide, Imanaka Yuichi
Department of Anesthesiology, Kansai Medical University, Hirakata, Osaka, Japan.
Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan.
Ann Vasc Dis. 2024 Dec 25;17(4):351-357. doi: 10.3400/avd.oa.24-00043. Epub 2024 Sep 4.
To comparatively examine in-hospital mortality between open aneurysm repair (OAR) and endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA) in Japan. Using administrative data, this retrospective cohort study analyzed rAAA patients treated at 482 Japanese acute care hospitals between April 1, 2018 and March 31, 2021. Patients were assigned to an OAR group or EVAR group. The propensity score for EVAR was calculated, and logistic regression analysis using inverse probability of treatment weighting was performed with in-hospital mortality as the dependent variable and surgical procedure (EVAR vs OAR) as the main independent variable of interest. The OAR group and EVAR group comprised 2650 patients from 372 hospitals and 2656 patients from 356 hospitals, respectively. In-hospital mortality was significantly higher ( <0.01) in the OAR group (11.7%) than in the EVAR group (9.4%). The logistic regression analysis calculated the odds ratio for in-hospital mortality to be 0.74 (95% confidence interval: 0.60-0.92; <0.01) in the EVAR group (reference: OAR group). EVAR was significantly associated with reduced in-hospital mortality and shorter hospitalizations in patients treated for rAAA in Japan.
为比较日本开放性腹主动脉瘤修复术（OAR）和血管腔内腹主动脉瘤修复术（EVAR）治疗破裂性腹主动脉瘤（rAAA）后的院内死亡率。本回顾性队列研究利用行政数据，分析了2018年4月1日至2021年3月31日期间在日本482家急性护理医院接受治疗的rAAA患者。患者被分为OAR组或EVAR组。计算EVAR的倾向评分，并以院内死亡率为因变量、手术方式（EVAR与OAR）为主要感兴趣的自变量，采用治疗权重逆概率进行逻辑回归分析。OAR组和EVAR组分别包括来自372家医院的2650例患者和来自356家医院的2656例患者。OAR组的院内死亡率（11.7%）显著高于EVAR组（9.4%）（<0.01）。逻辑回归分析计算出EVAR组院内死亡率的比值比为0.74（95%置信区间：0.60 - 0.92；<0.01）（参考：OAR组）。在日本，EVAR与rAAA患者院内死亡率降低和住院时间缩短显著相关。
