Descriptive and follow-up study of patients treated surgically for abdominal aortic aneurysm at tertiary hospitals in Spain
Por:
Bonfill, X, Quintana, MJ, Bellmunt, S, Suclupe, S, Gomez, E, Fernandez de Valderrama, I, Castejon, B, Miralles, M, Perez, E, Escudero, JR, Galvez Nunez, L, Gomez De La Camara, AG, Morales-Suarez-Varela, MM, Muriel, A, Plana, N, Rodriguez, AI
Publicada:
1 oct 2019
Resumen:
Background: The aim of this study was to assess potential variability in the clinical characteristics and treatment of patients undergoing elective surgery for abdominal aortic aneurysm (AAA) across five hospitals in Spain.
Methods: Multicenter, retrospective cohort study of patients diagnosed with AAA and treated with open surgical repair (OSR) or endovascular aneurysm repair (EVAR). We evaluated clinical and demographic variables, including comorbidity (Charlson Comorbidity Index [CCI]); anatomic characteristics; surgical risk (ASA Score); aneurysm characteristics; and in-hospital and overall mortality. All patients were followed for three years.
Results: A total of 186 patients were included, mean age 72.5 (standard deviation [SD], 8.4), mean CCI 2.04 (SD, 1.9). The surgical technique was EVAR in 46.8% of cases (N.=87) and OSR in 53.2% (N.=99). The in-hospital mortality rate was 2.2%, with no differences between groups. The overall mortality rate during follow-up (mean, 2.9 years) was 24.1% for EVAR versus 8.1% for the OSR group (odds ratio [OR], 3.62; 95% confidence interval [CI], 3.60-3.64; P=0.004). EVAR was the only independent risk factor for mortality (OR, 3.89; 95% CI: 3.87-3.92; P=0.004). Inter-center variability in the type of surgery was high, with EVAR accounting for 19.4% to 75% of the surgical procedures, depending on the treating center (P<0.001).
Conclusions: In this study the in-hospital mortality rates for elective EVAR and OSR were similar. However, after the follow-up, patients who underwent EVAR had a three-fold greater mortality rate than those treated with OSR. There was substantial inter-hospital variability, underscoring the need to standardize treatment selection in patients who undergo elective surgery for AAA repair.
Filiaciones:
Bonfill, X:
Santa Creu & St Pau IIB St Pau Univ Hosp, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
CIBER Epidemiol & Publ Hlth CIBERESP, Madrid, Spain
Autonomous Univ Barcelona, Barcelona, Spain
Quintana, MJ:
Santa Creu & St Pau IIB St Pau Univ Hosp, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
CIBER Epidemiol & Publ Hlth CIBERESP, Madrid, Spain
Bellmunt, S:
Vall dHebron Univ Hosp, Dept Angiol Vasc & Endovasc Surg, Barcelona, Spain
VHIR, Barcelona, Spain
Suclupe, S:
Santa Creu & St Pau IIB St Pau Univ Hosp, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
Autonomous Univ Barcelona, Barcelona, Spain
Gomez, E:
Univ Hosp St Pau Hosp Maig, Joint Serv Angiol Vasc & Endovasc Surg, Barcelona, Spain
Fernandez de Valderrama, I:
12 Octubre Univ Hosp, Madrid, Spain
Castejon, B:
Ramon y Cajal Univ Hosp, Madrid, Spain
Miralles, M:
Univ Valencia, Dept Surg, Valencia, Spain
Perez, E:
Cruces Univ Hosp, Baracaldo, Spain
Escudero, JR:
Autonomous Univ Barcelona, Barcelona, Spain
Univ Hosp St Pau Hosp Maig, Joint Serv Angiol Vasc & Endovasc Surg, Barcelona, Spain
CIBER Cardiovasc Dis CIBERCV, Madrid, Spain
Galvez Nunez, L:
La Fe Hosp, Valencia, Spain
Gomez De La Camara, AG:
CIBER Epidemiol & Publ Hlth CIBERESP, Madrid, Spain
12 Octubre Hosp, Madrid, Spain
Morales-Suarez-Varela, MM:
CIBER Epidemiol & Publ Hlth CIBERESP, Madrid, Spain
Univ Valencia, Valencia, Spain
Muriel, A:
CIBER Epidemiol & Publ Hlth CIBERESP, Madrid, Spain
Ramon & Cajal Hosp, Madrid, Spain
Hlth Res Inst IRYCIS, Madrid, Spain
Plana, N:
CIBER Epidemiol & Publ Hlth CIBERESP, Madrid, Spain
Ramon & Cajal Hosp, Madrid, Spain
Hlth Res Inst IRYCIS, Madrid, Spain
Rodriguez, AI:
12 Octubre Hosp, Madrid, Spain
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