Assessment of International Outcomes of Intact AAA Repair Over 9 Years Published
June 28, 2017—In European Journal of Vascular and Endovascular Surgery (EJVES), Jacob Budtz-Lilly, MD, et al published findings from an analysis of perioperative mortality after intact abdominal aortic aneurysm (AAA) repair in 11 countries over 9 years (2017;54:13–20).
The study was conducted because case mix and outcomes of complex surgical procedures vary over time and between regions. The investigators evaluated data on primary AAA repair from vascular surgery registries in 11 countries for the years 2005–2009 and 2010–2013. The study included 83,253 patients. Multivariate adjusted logistic regression analyses were carried out to adjust for variations in case mix.
As summarized in EJVES, over the two periods, the proportion of patients who were 80 years of age or older increased (18.5% vs 23.1%; P < .0001), as did the proportion of endovascular aneurysm repair (EVAR) (44.3% vs 60.6%; P < .0001). In the latter period, 25.8% of AAAs were < 5.5 cm. The mean annual volume of open repairs per center decreased from 12.9 to 10.6 between the two periods (P < .0001), and it increased for EVAR from 10.0 to 17.1 (P < .0001).
Overall, perioperative mortality decreased from 3% to 2.4% (P < .0001). Mortality for EVAR decreased from 1.5% to 1.1% (P < .0001), but the outcome worsened for open repair from 3.9% to 4.4% (P = .008). The perioperative risk was greater for octogenarians (overall, 3.6% vs 2.1%; P < .0001; open, 9.5% vs 3.6%; P < .0001; EVAR, 1.8% vs 0.7%; P < .0001) and women (overall, 3.8% vs 2.2%; P < .0001; open, 6% vs 4%; P < .0001; EVAR, 1.9% vs 0.9%; P < .0001). Perioperative mortality after repair of AAAs < 5.5 cm was greater with open repair than with EVAR, (4.4% vs 1%; P < .0001).
The investigators concluded that in this large international cohort, total perioperative mortality continues to decrease for the treatment of intact AAAs, and the number of EVAR procedures now exceeds open procedures. Mortality after EVAR has decreased, but mortality for open operations has increased. The perioperative mortality for small AAA treatment, particularly open surgical repair, is still considerable and should be weighed against the risk of rupture, reported the investigators in EJVES.