Trends in treatment of ruptured abdominal aortic aneurysm: impact of endovascular repair and implications for future care.
- 2013
Available online from MWHC library: 1997 - present, Available in print through MWHC library:1999-2007
CONCLUSIONS: Endovascular aneurysm repair use is increasing for RAAA and is more common in urban teaching hospitals while NO therapy is more common in rural hospitals. Endovascular aneurysm repair is associated with reduced mortality and complications across all age groups. Efforts to reduce mortality from RAAA should concentrate on reducing NO and OSR in patients who are suitable for EVAR. Copyright 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved. METHODS: Data from the Nationwide Inpatient Sample (NIS) from 2005 to 2009 were queried to identify patients older than 59 years with RAAA. Three groups were studied: nonoperative (NO), EVAR, and OSR. Chi-square analysis was used to determine the relationship between treatment type and patient demographics, clinical characteristics, and hospital type. The impact of EVAR compared with OSR on mortality and overall complications was examined using logistic regression analysis. OBJECTIVE: Our aim was to determine national trends in treatment of ruptured abdominal aortic aneurysm (RAAA), with specific emphasis on open surgical repair (OSR) and endovascular aneurysm repair (EVAR) and its impact on mortality and complications. RESULTS: We identified 21,206 patients with RAAA from 2005 to 2009, of which 16,558 (78.1%) underwent operative repair and 21.8% received no operative treatment. In the operative group, 12,761 (77.1%) underwent OSR and 3,796 (22.9%) underwent EVAR. Endovascular aneurysm repair was more common in teaching hospitals (29.1% vs 15.2%, p < .0001) and in urban versus rural settings. Nonoperative approach was twice as common in rural versus urban hospitals. Reduced mortality was seen in patients transferred from another institutions (31.2% vs 39.4%, p = 0.014). Logistic regression analysis demonstrated a benefit of EVAR on both complication rate (OR = 0.492; CI, 0.380-0.636) and mortality (OR=0.535; CI, 0.395-0.724).
English
1072-7515
*Aortic Aneurysm, Abdominal/su [Surgery] *Aortic Rupture/su [Surgery] *Endovascular Procedures/td [Trends] Aged Aged, 80 and over Aortic Aneurysm, Abdominal/mo [Mortality] Aortic Rupture/mo [Mortality] Endovascular Procedures/ae [Adverse Effects] Female Forecasting Humans Male Middle Aged Postoperative Complications/ep [Epidemiology] United States Vascular Surgical Procedures/ae [Adverse Effects] Vascular Surgical Procedures/td [Trends]