Endovascular Treatment of Abdominal Aortic Aneurysm and Impact of Yearly Caseload in the Quality Registry of the German Society for Vascular Surgery and Vascular Medicine (DGG).
Artur Besch, Jörg Heckenkamp, Farzin Adili, Markus Steinbauer, Livia Cotta, Christian-Alexander Behrendt
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引用次数: 0
Abstract
Objective: While the impact of yearly caseload on short term outcomes after abdominal aortic aneurysm (AAA) repair is still under debate, current data from the most decentralised healthcare system in Europe may offer valuable insights into an area that has changed considerably due to the widespread use of endovascular aortic aneurysm repair (EVAR).
Methods: This was a retrospective observational study of multicentric quality registry data from Germany on EVAR for intact and ruptured AAA between January 2017 and December 2023. The impact of yearly caseload and risk factors on in hospital mortality, complication rates, and failure to rescue after intact AAA repair was determined using multivariable logistic regression models.
Results: A total of 19 641 individuals (n = 2 576 females [13.1%]; median age 74 years, interquartile range [IQR] 68, 80) who underwent EVAR for intact (n = 18 763) or ruptured (n = 878) AAA were included at 194 centres. Among these, 44.3% of males were selected for treatment with maximum diameter < 55 mm (31.8% of females < 50 mm). After a median length of hospital stay of 6 days (IQR 5, 8) and 10 days (IQR 6, 17) for intact and ruptured cases, 1.0% and 19.7% died, respectively. The rate of any post-interventional complication was 8.2% and 31.4%, respectively. An endoleak was apparent in the completion angiography in 17.6% of intact cases (14.5% type II) and 18.2% of ruptured cases (11.0% type II). The median yearly EVAR caseload per centre was 34.7 (IQR 22.1, 58.4), and 25.1% of patients were treated at centres above the 75th percentile. An American Society of Anesthesiologists (ASA) score ≥ 4, juxtarenal aneurysm extent, severe heart failure, female sex, larger aneurysm diameter, older age, and history of cancer, chronic obstructive pulmonary disease, and stroke were associated with in hospital death after intact AAA repair, but not yearly caseload or severe chronic kidney failure. Sensitivity analyses including different outcomes were confirmative, except for a statistically significant impact of yearly caseload on the composite endpoint of any post-interventional complication (p = .008).
Conclusion: This large registry analysis was unable to confirm an impact of caseload on short term results after EVAR for intact AAA. Future studies should address long term outcomes after EVAR as well as the underlying reasons for the considerably large proportion of small AAA treatment.
期刊介绍：
The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles.
Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.
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