National trends in open surgical, endovascular, and branched-fenestrated endovascular aortic aneurysm repair in Medicare patients.
National trends in open surgical, endovascular, and branched-fenestrated endovascular aortic aneurysm repair in Medicare patients.
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DOI：
10.1016/j.jvs.2017.09.046
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发表时间：
2018-06
影响因子：
4.3
通讯作者：
Fillinger MF
中科院分区：
文献类型：
--
作者：
Suckow BD;Goodney PP;Columbo JA;Kang R;Stone DH;Sedrakyan A;Cronenwett JL;Fillinger MF
开放式腹主动脉瘤（AAA）修复可有效防止AAA患者破裂，通常作为反映医院和外科医生心血管护理专业知识的指标进行研究。然而，鉴于血管内腹主动脉瘤修复（EVAR）（如分支/开窗EVAR）的最新进展，尚不清楚在日常实践中开放手术修复的普遍程度。我们分析了2003年至2013年Medicare受益人的AAA开放性修复、EVAR和分支/开窗EVAR的趋势。我们使用医疗保险B部分索赔来确定这些修复类型的数量，并在研究期间每年进行。我们评估了地区和国家在患者特征和手术量方面的趋势。2003年至2013年间，按服务收费的医疗保险患者进行的AAA修复手术总数下降了26%，从31,582例下降到23,421例（p<0.001），而2005年的峰值为32,540例（自2005年以来下降了28%）。开放的AAA维修数量稳步下降了76%，从2003年的20,533例下降到2013年的4,916例（p < 0.001）。虽然evar的数量从2003年的11049例增加到2011年的19247例（p <0.001），但从那以后，它在2013年总共下降了15%，只有16362例（p <0.001）。分支/开窗EVAR自2011年引进后，从2011年的335例持续上升至2013年的2143例（p < 0.001）。到2013年，美国几乎所有医院转诊地区的开放式AAA修复率都处于2003年最低的五分之一。在过去十年中，开放式AAA修复数量下降了近80%，而传统EVAR略有下降，分支/开窗EVAR迅速推广到全国实践。这些结果表明，现在进行开放式AAA修复的次数太少，不足以作为评估医院和外科医生心血管护理质量的指标。此外，外科培训模式需要反映出必要的动态变化，以确保外科医生和介入医生能够安全地执行这些高风险的外科手术。
Open abdominal aortic aneurysm (AAA) repair effectively prevents rupture for patients with AAA, and is commonly studied as a metric reflecting hospital and surgeon expertise in cardiovascular care. However, given recent advances in endovascular abdominal aortic aneurysm repair (EVAR) such as branched/fenestrated EVAR, it is unknown how commonly open surgical repair is still used in everyday practice. We analyzed trends in open AAA repair, EVAR, and branched/fenestrated EVAR for AAA in Medicare beneficiaries from 2003 to 2013. We used Medicare Part B claims to ascertain counts of these repair types and annually over the study period. We assessed regional and national trends in patient characteristics and procedure volume. Between 2003 and 2013, the total number of AAA repairs performed in fee-for-service Medicare patients declined by 26% from 31,582 to 23,421 (p<0.001), after a peak number of 32,540 was performed in 2005 (28% decline since 2005). The number of open AAA repairs steadily declined by a total of 76%, from 20,533 in 2003 to 4,916 in 2013 (p < 0.001). While the number of EVARs increased from 11,049 in 2003 to 19,247 in 2011 (p <0.001), it has since declined a total of 15% to only 16,362 repairs in 2013 (p <0.001). After its introduction in 2011, the number of branched/fenestrated EVAR cases continuously rose from 335 procedures in 2011 to 2,143 procedures in 2013 (p < 0.001). By 2013 virtually all hospital referral regions in the United States had rates of open AAA repair which would have been in the lowest quintile of volume in 2003. The number of open AAA repairs fell by nearly 80% during the last decade, while traditional EVAR declined slightly and branched/fenestrated EVAR rapidly disseminated into national practice. These results suggest that open AAA repair is now performed too infrequently to be used as a metric in the assessment of hospital and surgeon quality in cardiovascular care. Further, surgical training paradigms will need to reflect the changing dynamics necessary to ensure surgeons and interventionists can safely perform these high-risk surgical procedures.
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DOI：
10.1056/nejmoa1405778
发表时间：
2015-07-23
期刊：
The New England journal of medicine
影响因子：
--
作者：
Schermerhorn ML;Buck DB;O'Malley AJ;Curran T;McCallum JC;Darling J;Landon BE
通讯作者：
Landon BE
影响因子：
4.3
作者：
Dua, Anahita;Kuy, SreyRam;Desai, Sapan S.
通讯作者：
Desai, Sapan S.
DOI：
10.1161/circoutcomes.109.848465
发表时间：
2009-11-01
影响因子：
6.9
作者：
Holt, Peter J. E.;Poloniecki, Jan D.;Thompson, Matt M.
通讯作者：
Thompson, Matt M.
影响因子：
4.3
作者：
Thompson, Matthew;Holt, Peter;Forbes, Thomas L.
通讯作者：
Forbes, Thomas L.
影响因子：
2.5
作者：
Cronenwett, Jack L.
通讯作者：
Cronenwett, Jack L.