Open versus endovascular abdominal aortic aneurysm repair in VA hospitals
Open versus endovascular abdominal aortic aneurysm repair in VA hospitals
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DOI：
10.1016/j.jamcollsurg.2006.01.005
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发表时间：
2006-04-01
影响因子：
5.2
通讯作者：
Ashton, CM
中科院分区：
文献类型：
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作者：
Bush, RL;Johnson, ML;Ashton, CM
背景技术背景：与传统开放手术修复相比，腹主动脉瘤腔内修复术（EVAR）已被证明可降低围手术期发病率和死亡率。我们进行了一项回顾性队列研究，前瞻性收集了来自退伍军人事务部的数据，以检查择期腹主动脉瘤修复术后的结局。研究设计：我们研究了1,904例接受择期腹主动脉瘤修复术的患者的30天死亡率、1年生存率和术后并发症（腹主动脉瘤腔内修复术n = 717 [37.7%];开放n = 1，187 [62.3%]），2001年5月1日至2003年9月30日期间，在123家退伍军人事务部医院进行。我们调查了患者、手术和医院变量对结局的影响。结果：腹主动脉瘤腔内修复术患者的30天（3.1%对5.6%，p = 0.01）和1年死亡率（8.7%对12.1%，p = 0.018）显著低于开放修复术患者。腹主动脉瘤腔内修复术与术后30天死亡率降低相关（校正比值比[OR] = 0.59; 95% CI = 0.36，0.99; p = 0.04）。腹主动脉瘤腔内修复术后围手术期并发症的风险要低得多（15.5% vs 27.7%; p < 0.001;未校正OR 0.48; 95% CI = 0.38，0.61; P < 0.001）。在低容量医院手术的患者（整个队列的25%）更有可能接受开放性修复术（31.3%与15.9%腹主动脉瘤腔内修复术; p < 0.001），调整后的30天死亡风险增加近2倍（OR = 1.9; 95% CI = 1.19，2.98; p = 0.006）。结论：在日常实践中，与接受开放性修复术的患者相比，接受择期腹主动脉瘤腔内修复术的退伍军人的围手术期死亡率和发病率显著降低。微创方法的受益在该队列中显而易见，但我们建议在获得器械耐久性的长期数据之前，谨慎选择腹主动脉瘤腔内修复术用于所有择期腹主动脉瘤修复术。
BACKGROUND: Endovascular abdominal aortic aneurysm repair (EVAR), when compared with conventional open surgical repair, has been shown to reduce perioperative morbidity and mortality. We performed a retrospective cohort Study with prospectively collected data from the Department of Veterans Affairs to examine outcomes after elective aneurysm repair.STUDY DESIGN: We studied 30-day mortality, 1-year survival,and postoperative complications in 1,904 patients who underwent elective abdominal aortic aneurysm repair (EVAR n = 717 [37.7%]; open n = 1,187 [62.3%]) at 123 Department of Veterans Affairs hospitals between May 1, 2001 and September 30, 2003. We investigated the influence of patient, operative, and hospital variables on outcomes.RESULTS: Patients undergoing EVAR had significantly lower 30-day (3.1% versus 5.6%, p = 0.01) and 1-year mortality rates (8.7% versus 12.1%, p = 0.018) than patients having open repair. EVAR was associated with I decrease in 30-day postoperative mortality (adjusted odds ratio[OR] = 0.59; 95% CI = 0.36, 0.99; p = 0.04). The risk of perioperative complications was much less after EVAR (15.5% versus 27.7%; p < 0.001; unadjusted OR 0.48; 95% CI = 0.38, 0.61; P < 0.001). Patients operated on at low volume hospitals (25% of entire cohort) were more likely to have had open repair (31.3% compared with 15.9% EVAR; p < 0.001) and a nearly two-fold increase in adjusted 30-day mortality risk (OR = 1.9; 95% CI = 1.19, 2.98; p = 0.006).CONCLUSIONS: In routine daily practice, veterans who undergo elective EVAR have substantially lower perioperative mortality and morbidity rates compared with patients having open repair. The benefits of a minimally invasive approach were readily apparent in this cohort, but we recommend using caution in choosing EVAR for all elective abdominal aortic aneurysm repairs until longer-term data on device durability are available.