Low Post-operative Mortality after Surgery on Patients with Screening-detected Abdominal Aortic Aneurysms: A Swedvasc Registry Study

Linné, Anneli; Smidfelt, Kristian; Langenskiöld, Marcus; Hultgren, Rebecka; Nordanstig, Joakim; Kragsterman, Björn; Lindström, David

doi:10.1016/j.ejvs.2014.08.024

Cited by 10 publications

(5 citation statements)

References 31 publications

(15 reference statements)

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“…DREAM study reported the 30-day mortality after EVAR as 0.4% [ 12 ]. In Swedvasc registry patients with screening-detected AAA had 1.0% mortality after surgery and 0% after EVAR [ 13 ]. Age was an independent risk covariant of short-term mortality in all patients and in 70+ group.…”

Section: Discussionmentioning

confidence: 99%

Short- and long-term survival after open versus endovascular repair of abdominal aortic aneurysm—Polish population analysis

Symonides

Śliwczyński²,

Gałązka

et al. 2018

PLoS ONE

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ObjectivesThe aim of the study was to compare short and long-term mortality and readmissions in patients with non-ruptured abdominal aortic aneurysm (AAA) treated with endovascular aortic repair (EVAR) or open aneurysm repair (OAR).DesignRetrospective survival analysis based on prospectively collected medical records of the national Polish public health insurer.MaterialsIn the National Health Fund database we identified all patients who underwent elective open or endovascular treatment of AAA between January 1st 2011 and March 22nd 2016. The data on mortality, selected concomitant diseases and readmissions were collected. A total of 7805 patients (mean age 70.9±8.1 yrs, 85.8% males) underwent OAR (n = 2336) or EVAR (n = 5469). A median follow up was 27.5 months (IQR range 10.0–38.4 months).MethodsThe primary outcome variable was all-cause mortality, secondary outcomes included 30-day mortality and readmissions. Kaplan–Meier (K-M), Cox proportional-hazards and propensity score analyses were performed for primary and secondary outcomes adjusting for repair type of AAA (OAR vs. EVAR), age, sex and concomitant diseases.ResultsEVAR patients had higher all-cause mortality (6.4% vs. 4.6% P = 0.002, adjHR 1.34, 95%CI 1.07–1.67, P = 0.010) compared with OAR. The mortality risks for OAR patients decreased below those for EVAR patients after 9.9 months. Of all the tested confounding factors only age independently and significantly influenced long-term mortality. Readmissions occurred more often in EVAR than in OAR (16.5% vs. 8.4% P<0.001, adjHR 2.15, 95%CI 1.84–2.52, P<0.001) independently from other covariants. Survival and readmissions Kaplan-Meier curves remained statistically different between OAR and EVAR patients after propensity score matching.ConclusionsSurvival benefit of EVAR over OAR disappeared early during the first year after procedure, particularly in patients below 70 years of age, accompanied by an increased frequency of readmissions of EVAR patients. Our data suggest re-evaluation of the strategy for AAA management in vascular units in the country.

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Section: Discussionmentioning

confidence: 99%

Short- and long-term survival after open versus endovascular repair of abdominal aortic aneurysm—Polish population analysis

Symonides

Śliwczyński²,

Gałązka

et al. 2018

PLoS ONE

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“…Preoperative renal failure was defined as a serum creatinine level above 150 μmol/L in accordance with previous Swedvasc studies. 13,14…”

Section: Methodsmentioning

confidence: 99%

Routine open abdomen treatment compared with on-demand open abdomen or direct closure following open repair of ruptured abdominal aortic aneurysms: A propensity score–matched study

et al. 2019

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Objective: To investigate whether a strategy of treatment with a primarily open abdomen improves outcome in terms of mortality and major complications in patients treated with open repair for a ruptured abdominal aortic aneurysm compared to a strategy of primary closure of the abdomen. Design: Retrospective cohort study. Methods: Patients treated with a primarily open abdomen at a centre where this strategy was routine in most ruptured abdominal aortic aneurysm patients were compared to a propensity score–matched control group of patients who had the abdomen closed at the end of the primary operation in a majority of the cases. Results: In total, 79 patients treated with a primarily open abdomen after open repair for ruptured abdominal aortic aneurysm at Sahlgrenska University Hospital were compared to a propensity score–matched control group of 148 patients. The abdomen was closed at the end of the procedure in 108 (73%) of the control patients. There was no difference in 30-day mortality between patients treated with a primarily open abdomen at Sahlgrenska University Hospital and the controls, 21 (26.6%) versus 49 (33.1%), p = 0.37. The adjusted odds ratio for mortality at 30 days was 0.66 (95% confidence interval: 0.35–1.25) in patients treated with a primarily open abdomen at Sahlgrenska University Hospital compared to the controls. No difference was observed between the groups regarding 90-day mortality, postoperative renal failure requiring renal replacement therapy, postoperative intestinal ischaemia necessitating bowel resection or postoperative bleeding requiring reoperation. Conclusions: The study did not show any survival advantage or difference in major complications between patients treated with a primarily open abdomen after open repair for ruptured abdominal aortic aneurysm and propensity-matched controls where the abdomen was primarily closed in a majority of the cases.

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“…During the Swedvasc period, screening for AAA has been successfully introduced since 2006 and from 2015, 65-year-old males in the whole country are invited to attend an ultrasonographic investigation [ 28 ]. In this group of patients open repair is significantly more frequent than EVAR as compared to those with AAAs not detected by screening[ 18 ]. In patients treated with open repair there was no difference in 30-day, 90-day or 1‑year mortality in AAA detected by screening compared to AAA not detected by screening in controls (1.0% vs. 3.2%, 2.1 vs. 4.5% and 4.1 vs. 5.8%, respectively, all not significant).…”

Section: Treatment Of Aaa As Reflected In Swedvascmentioning

confidence: 99%

Treatment of aortic aneurysms registered in Swedvasc

et al. 2018

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Swedvasc is a registry for vascular surgical procedures, both open and endovascular. It was started in 1987 and since 1994 the whole population of Sweden is covered, at present around 10 million inhabitants. In a recent external validation, it was found to be highly accurate with abdominal aortic aneurysm surgery correctly reported in >96%. In this paper various factors explaining the almost 100% coverage are discussed, one important being that the registry has been developed and maintained within the profession of vascular surgery and not dictated by authorities. Another factor of importance is the possibility to use data in various research projects and so far 15 PhD theses have used Swedvasc data. To exemplify the practical use of the registry, the treatment of abdominal aortic aneurysms is scrutinized and among the various complications abdominal compartment syndrome is analyzed. Several significant temporal changes have been observed over the almost 25 years of Swedvasc: increasing use of endovascular surgery, treatment of aneurysms detected by screening , decreasing treatment for rupture, improved outcome, increasing treatment of older patients and patients with comorbid conditions. In conclusion, a high quality national vascular registry can be valid with high compliance and can be used to study population-based development of treatment and outcome. It can also be used to perform international comparisons with other registries, thereby getting an indication of the quality of care.

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Low Post-operative Mortality after Surgery on Patients with Screening-detected Abdominal Aortic Aneurysms: A Swedvasc Registry Study

Cited by 10 publications

References 31 publications

Short- and long-term survival after open versus endovascular repair of abdominal aortic aneurysm—Polish population analysis

Short- and long-term survival after open versus endovascular repair of abdominal aortic aneurysm—Polish population analysis

Routine open abdomen treatment compared with on-demand open abdomen or direct closure following open repair of ruptured abdominal aortic aneurysms: A propensity score–matched study

Treatment of aortic aneurysms registered in Swedvasc

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