Long-term survival after endovascular and open repair of unruptured abdominal aortic aneurysm

Johal, Amundeep S.; Loftus, Ian; Boyle, J R; Heikkilä, Katriina; Waton, Sam; Cromwell, David

doi:10.1002/bjs.11215

Cited by 29 publications

(24 citation statements)

References 23 publications

(61 reference statements)

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“…A recently published study used HES data to investigate long term outcomes after repair of unruptured AAAs in 37 138 patients and found that rupture rates were higher for EVAR. 29 There was notable variation in the use of EVAR and open surgery between trusts in the present dataset. Differences in presentation, anatomical features, resource availability and patient preference may also play a role here.…”

Section: Discussionmentioning

confidence: 77%

Editor's Choice – Volume–Outcome Relationships in Elective Abdominal Aortic Aneurysm Surgery: Analysis of the UK Hospital Episodes Statistics Database for the Getting It Right First Time (GIRFT) Programme

Gray¹,

Day²,

Horrocks³

2020

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS Volumeeoutcome relationships in abdominal aortic aneurysm surgery in England were investigated in the light of the introduction of a screening programme for older males, recent initiatives to centralise services, and greater use of endovascular techniques. Following these changes, good evidence was found of a volume eoutcome relationship for open surgery but not for endovascular aneurysm repair. Objective: To investigate whether a volumeeoutcome relationship exists for elective abdominal aortic aneurysm (AAA) surgery conducted within the National Health Service (NHS) in England. Methods: This was an analysis of administrative data. Data were extracted from the Hospital Episodes Statistics database for England from April 2011 to March 2019 for all adult admissions for elective infrarenal AAA surgery. Data were extracted for the NHS trust and surgeon undertaking the procedure, the surgical technique used (open or endovascular), the financial year of admission, length of hospital and critical care stay during the procedure and subsequent emergency re-admissions (primary outcome) and deaths within 30 days. Multilevel modelling was used to adjust for hierarchy and confounding. Results: A dataset of 31 829 procedures (8867 open, 22 962 endovascular) was extracted. For open surgery, lower trust annual volume was associated with higher 30 day emergency re-admission rates and higher 30 day mortality. For open surgery, lower surgeon annual volume was associated with higher 30 day mortality and length of hospital stay greater than the median. For endovascular surgery, lower surgeon annual volume was associated with not having an overnight stay in critical care. None of the other volumeeoutcome relationships investigated was significant. Conclusion: For elective infrarenal AAA surgery in the UK NHS, there was strong evidence of a volumeeoutcome relationship for open surgery. However, evidence for a volumeeoutcome relationship is dependent on the specific procedure undertaken and the outcome of interest.

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Section: Discussionmentioning

confidence: 77%

Editor's Choice – Volume–Outcome Relationships in Elective Abdominal Aortic Aneurysm Surgery: Analysis of the UK Hospital Episodes Statistics Database for the Getting It Right First Time (GIRFT) Programme

Gray¹,

Day²,

Horrocks³

2020

European Journal of Vascular and Endovascular Surgery

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“…These data have recently been corroborated by a large series from the United Kingdom of over 38,000 unruptured AAA repairs collected by the UK Hospital Episode Statistic. 10 EVAR was associated with higher 10-year mortality and higher risk of rupture over 9 years than open surgical repair (3.4% vs 0.9%).…”

mentioning

confidence: 92%

Introduction of New Medical Devices: Lessons Learned From Experience With Endovascular Aneurysm Sealing

Singh

Boyle

2019

J Endovasc Ther

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“…Johal et al recently aimed to examine patterns of 10-year survival after elective repair of unruptured AAA and investigated the survival among patients of different age and different co-morbidity score pro les from the English National Health register 25 . The long-term survival patterns after elective open repair and EVAR for unruptured AAA varied markedly across patients with different age and co-morbidity pro les.…”

Section: Association Of Cardio-metabolic Factors With Post-operative mentioning

confidence: 99%

Nationwide Study of Mortality After Abdominal Aortic Aneurysm Repair in France 2010- 2019

Raffort¹,

Lareyre²,

Fabre³

et al. 2021

Preprint

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ObjectiveThe aim of this nationwide study was to analyze mortality in patients undergoing AAA repair and to explore the association between cardio-metabolic factors with clinical presentation and post-operative mortality. MethodsThis ten-year retrospective, multicenter study based on the French National electronic health data included patients undergoing AAA repair between 2010 and 2019. Post-operative mortality was analyzed using Kaplan-Meier curve survival and Log-Rank tests. A multivariate regression analysis was performed to calculate Hazard Ratios.ResultsOver 79 935 patients who underwent AAA repair, 61 146 patients (76.5%) had at least one hospital-readmission after the AAA repair, for a mean follow-up of 3.5 years +/- 2.5. The in-hospital mortality was 4 581 (5.8%) and the total post-operative mortality was 12 400 (20.3%). Age over 64 years old, the presence of AAA rupture and in-hospital readmission at 30-day were predictors of post-operative mortality (HR=1.59 CI95%=1.51 - 1.67; HR=1.49 CI95%=1.36 - 1.62 and HR=1.92, CI95%=1.84 - 2.00). Cardio-metabolic factors were negatively associated with AAA rupture (OR= 0.44 CI95%=0.41-0.47 for dyslipidemia, OR=0.75 CI95%=0.70-0.8 for hypertension). ConclusionThe negative association observed between cardio-metabolic comorbidities and AAA rupture suggests that AAA may be underdiagnosed in patients without known comorbidities and highlights the interest of AAA screening.

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Long-term survival after endovascular and open repair of unruptured abdominal aortic aneurysm

Cited by 29 publications

References 23 publications

Editor's Choice – Volume–Outcome Relationships in Elective Abdominal Aortic Aneurysm Surgery: Analysis of the UK Hospital Episodes Statistics Database for the Getting It Right First Time (GIRFT) Programme

Editor's Choice – Volume–Outcome Relationships in Elective Abdominal Aortic Aneurysm Surgery: Analysis of the UK Hospital Episodes Statistics Database for the Getting It Right First Time (GIRFT) Programme

Introduction of New Medical Devices: Lessons Learned From Experience With Endovascular Aneurysm Sealing

Nationwide Study of Mortality After Abdominal Aortic Aneurysm Repair in France 2010- 2019

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