Epidemiology of aortic aneurysm repair in the United States from 2000 to 2010
Epidemiology of aortic aneurysm repair in the United States from 2000 to 2010
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DOI：
10.1016/j.jvs.2014.01.007
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发表时间：
2014-06-01
影响因子：
4.3
通讯作者：
Desai, Sapan S.
中科院分区：
文献类型：
--
作者：
Dua, Anahita;Kuy, SreyRam;Desai, Sapan S.
目的：动脉瘤腔内修复术（EVAR）的广泛应用导致开放性动脉瘤修复术（OAR）的快速下降，并提高了患者生存率，尽管总体护理成本较高。本报告的目的是评价腹主动脉瘤未破裂和破裂的发生率、腹主动脉瘤腔内修复术和腹主动脉瘤腔内修复术治疗的国家趋势，并比较这两种方法的总体患者特征和临床结局。全国住院病人横断面样本的回顾性分析（2000-2010）用于评价未破裂和破裂AAA的腹主动脉瘤腔内修复术和OAR相关的患者特征和结局。通过使用来自美国的数据，数据被外推以代表人口水平的统计数据。S.人口普查局。使用描述性statistics.Results：有101，978例患者在全国住院样本的AAAs影响超过11年的跨度，这项研究的平均年龄为73岁，21%是女性，90%是白色。总体住院死亡率为7%，中位住院时间（LOS）为5天，中位住院费用为58，305美元。破裂患者的住院死亡率高13倍，中位LOS为9天，中位费用为84，744美元。对于未破裂和破裂患者，腹主动脉瘤腔内修复术与较低的住院死亡率相关（未破裂组4% vs 1%，破裂组41% vs 27%; P <0.001），中位LOS缩短（7比2; 9比6; P < .001），但住院费用增加了27%-36%。腹主动脉瘤腔内修复术的总体使用在过去10年中急剧上升（占AAA修复总数的5.2%至74%），尽管AAA总数保持稳定在每年45，000例。在此期间，破裂和未破裂病例的住院死亡率下降了50%以上。尽管治疗成本高出27%-36%，但死亡率更低，LOS更短，这继续证明腹主动脉瘤腔内修复术的使用优于OAR。对于解剖结构合适的患者，腹主动脉瘤腔内修复术应是破裂和未破裂AAA的首选治疗方法。
Objective: Broad application of endovascular aneurysm repair (EVAR) has led to a rapid decline in open aneurysm repair (OAR) and improved patient survival, albeit at a higher overall cost of care. The aim of this report is to evaluate national trends in the incidence of unruptured and ruptured abdominal aortic aneurysms (AAAs), their management by EVAR and OAR, and to compare overall patient characteristics and clinical outcomes between these two approaches.Methods: A retrospective analysis of the cross-sectional National Inpatient Sample (2000-2010) was used to evaluate patient characteristics and outcomes related to EVAR and OAR for unruptured and ruptured AAAs. Data were extrapolated to represent population-level statistics through the use of data from the U. S. Census Bureau. Comparisons between groups were made with the use of descriptive statistics.Results: There were 101,978 patients in the National Inpatient Sample affected by AAAs over the 11-year span of this study; the average age was 73 years, 21% were women, and 90% were white. Overall in-hospital mortality rate was 7%, with a median length of stay (LOS) of 5 days and median hospital charges of $58,305. In-hospital mortality rate was 13 times greater for ruptured patients, with a median LOS of 9 days and median charges of $84,744. For both unruptured and ruptured patients, EVAR was associated with a lower in-hospital mortality rate (4% vs 1% for unruptured and 41% vs 27% for ruptured; P < .001 for each), shorter median LOS (7 vs 2; 9 vs 6; P < .001) but a 27%-36% increase in hospital charges.Conclusions: The overall use of EVAR has risen sharply in the past 10 years (5.2% to 74% of the total number of AAA repairs) even though the total number of AAAs remains stable at 45,000 cases per year. In-hospital mortality rates for both ruptured and unruptured cases have fallen by more than 50% during this time period. Lower mortality rates and shorter LOS despite a 27%-36% higher cost of care continues to justify the use of EVAR over OAR. For patients with suitable anatomy, EVAR should be the preferred management of both ruptured and unruptured AAAs.