Differences in readmissions after open repair versus endovascular aneurysm repair.
Differences in readmissions after open repair versus endovascular aneurysm repair.
复制标题
开放修复与血管内动脉瘤修复后再入院的差异。
DOI：
10.1016/j.jvs.2012.07.005
复制
发表时间：
2013
影响因子：
4.3
通讯作者：
Lee,JasonT
中科院分区：
文献类型：
--
作者：
Casey,Kevin;Hernandez-Boussard,Tina;Mell,MatthewW;Lee,JasonT
目的腹主动脉瘤修补术(AAA)后再干预率腔内修补术(EVAR)高于开放修补术(EVAR)，主要是由于内漏的治疗，而开放手术治疗肠梗阻和腹股沟腹股沟高于开放修补术。然而，对于不需要干预的非手术条件和并发症，EVAR或开放修补术后的再住院率没有很好的记录。我们试图在开放修复和EVAR后的第一年内确定所有原因重新入院的原因。方法从医疗保健和利用项目州住院数据库中确定在6年内在加利福尼亚州接受选择性AAA修复的患者。所有在加利福尼亚州≤再次住院的患者在他们的指数程序中有1年的时间被纳入评估。结果2003-2008年间，择期AAA修补术15,736例，其中9356例(60%)，开放修补术6380例(40%)。术后1年开放修补术的再住院率为52.1%，EVAR术后的再住院率为55.4%(P=0.003)。与任何类型的AAA修复后的再入院相关的三个最常见的基本诊断是生长不旺盛、心脏问题和感染。当按修复类型分层时，与EVAR相比，接受开放修复的患者更有可能再次入院，其主要诊断与生长失败、心脏并发症和感染有关(均P<；.001)。然而，接受EVAR的患者更有可能再次入院，主要诊断为与设备相关的并发症(P=.05)、心脏并发症和感染。结论择期AAA修补术后1年内再次住院率EVAR组高于开放修补组。再入院的原因在两组人群中有所不同，但与开放修复后开放手术的规模、EVAR后的装置问题以及任何一种干预后常见的心脏和感染并发症有关。对这些再入院原因的系统分析可能会改善患者在选择性动脉瘤修复后的预期和护理。
OBJECTIVEReintervention rates after repair of abdominal aortic aneurysm (AAA) are higher for endovascular repair (EVAR) than for open repair, mostly due to treatment for endoleaks, whereas open surgical operations for bowel obstruction and abdominal hernias are higher after open repair. However, readmission rates after EVAR or open repair for nonoperative conditions and complications that do not require an intervention are not well documented. We sought to determine reasons for all-cause readmissions within the first year after open repair and EVAR.METHODSPatients who underwent elective AAA repair in California during a 6-year period were identified from the Health Care and Utilization Project State Inpatient Database. All patients who had a readmission in California ≤1 year of their index procedure were included for evaluation. Readmission rates and primary and secondary diagnoses associated with each readmission were analyzed and recorded.RESULTSFrom 2003 to 2008, there were 15,736 operations for elective AAA repair, comprising 9356 EVARs (60%) and 6380 open repairs (40%). At 1 year postoperatively, the readmission rate was 52.1% after open repair and 55.4% after EVAR (P = .0003). The three most common principle diagnoses associated with readmission after any type of AAA repair were failure to thrive, cardiac issues, and infection. When stratified by repair type, patients who underwent open repair were more likely to be readmitted with primary diagnoses associated with failure to thrive, cardiac complications, and infection compared with EVAR (all P < .001). Those who underwent EVAR were more likely, however, to be readmitted with primary diagnoses of device-related complications (P = .05), cardiac complications, and infection.CONCLUSIONSTotal readmission rates within 1 year after elective AAA repair are greater after EVAR than after open repair. Reasons for readmission vary between the two cohorts but are related to the magnitude of open surgery after open repair, device issues after EVAR, and the usual cardiac and infectious complications after either intervention. Systems-based analysis of these causes of readmission can potentially improve patient expectations and care after elective aneurysm repair.