Editor's Choice – Variation in Intact Abdominal Aortic Aneurysm Repair Outcomes by Country: Analysis of International Consortium of Vascular Registries 2010 – 2016

Abstract

WHAT THIS PAPER ADDSIn this study of over 100 000 intact abdominal aortic aneurysm repairs, an increase in the proportion of patients undergoing endovascular aneurysm repair (EVAR) over time has been demonstrated. Peri-operative mortality rates are falling for both EVAR and open surgical repair. Outcomes however are poorer in women and octogenarians, and future efforts should be focused on improving outcomes for these patients.Objective: Outcomes for intact abdominal aortic aneurysm (AAA) repair vary over time and by healthcare system, country, and surgeon. The aim of this study was to analyse peri-operative mortality for intact AAA repair in 11 countries over time and compare outcomes by gender, age, and geographical location. Methods: Prospective data on primary repair of intact AAA were collected from 11 countries through the International Consortium of Vascular Registries (ICVR) and analysed for two time periods, 2010 e 2013 and 2014 e 2016. The primary outcome was peri-operative mortality after endovascular aneurysm repair (EVAR) and open surgical repair (OSR). Multivariable logistic regression models were used to adjust for differences in patient characteristics. Results: A total of 103 715 patients were included. The percentage of patients undergoing EVAR increased from 63.6% to 71.2% (p < .001) over the study period. This proportion varied by country from 35% in Hungary to 81% in the United States. Overall peri-operative mortality decreased from 2.1% to 1.6 % (p < .001). Mortality also declined significantly over time for both OSR 4.2% to 3.6 % (p ¼ .002) and EVAR 1.0% to 0.7% (p ¼ .002). Mortality was significantly higher for female than male patients (3.0% vs. 1.6% p < .001). The percentage of patients > 80 years old undergoing AAA repair remained constant at 23.6% (p ¼ .91). Peri-operative mortality was higher for patients > 80 years than for those < 80 years old (2.7% vs. 1.6% p < .001). Fortysix per cent (n ¼ 275) of all EVAR deaths occurred in the over 80s. Conclusion:The proportion of AAA repairs performed using EVAR has increased over time. Peri-operative mortality continues to decline for both OSR and EVAR. Outcomes however were significantly worse for both women and those aged over 80, so efforts should be focused on these patient groups to further reduce elective AAA mortality rates.

Endovascular versus open repair in patients with abdominal aortic aneurysm: a claims-based data analysis in Japan

“…Historically, highly coordinated cooperative efforts of vascular surgeons, such as the VASCUNET and the VQI, have helped develop evidence-based guidelines to improve the outcomes of patients with AAA 38. In addition, the Medical Device Epidemiology Network (MDEpiNet), a public-private partnership supported by the US FDA, has established the ICVR 39–41. Japanese surgeons also contributed to internationally coordinated registry networks 42.…”

“…38 In addition, the Medical Device Epidemiology Network (MDEpiNet), a public-private partnership supported by the US FDA, has established the ICVR. [39][40][41] Japanese surgeons also contributed to internationally coordinated registry networks. 42 One important lesson from the experiences of international collaborations is to have governing structures for data sharing.…”

Pro Endo: No Need for Open Any More ... Surveillance is All Important

“…Eine systematische Überprüfung der 10 am häufigsten verwendeten Risikoscores zur Vorhersage der perioperativen Mortalität nach elektiver offener AAA-Reparatur kam zu dem Schluss, dass die meisten nicht konsistent validiert waren, inkonsistent durchgeführt wurden oder für die klinische Anwendung unpraktisch waren [5]. Seitdem werden fast 60 % der Patienten mit BAA sowohl bundesweit als auch global mit EVAR behandelt [6]. Trotz der verbreiteten Anwendung gibt es noch immer Untergruppen des Patientenkollektivs, bei denen der Nutzen von EVAR nicht eindeutig nachgewiesen wurde.…”

“…Die in diesem Zusammenhang am häufigsten diskutierte Untergruppe ist der junge Patient mit wenigen Risikofaktoren, der als Grundlage für die folgende Debatte dient. Obwohl dieses Patientenkollektiv zunächst als selten und somit zu vernachlässigen galt, ist diese Therapieentscheidung eine tatsächliche Kontroverse, da fast ein Drittel der Patienten, die eine Aneurysmabehandlung erhalten, jünger als 64 Jahre sind [6].…”

Quality Improvement in Vascular Surgery

“…Within established registry networks, data can be used to benchmark practice and outcomes between centres and countries to identify clinical areas and key parameters where quality improvement efforts could drive significant patient benefit. 14 With the right conditions in place, collaborative quality improvement has been shown to be an effective way to improve outcomes, and there is proven efficacy in vascular surgery. The next step is to build on this knowledge with dedicated, data monitored and evidence based collaborative quality improvement efforts that could be coordinated on a European level.…”