Age-related trends in utilization and outcome of open and endovascular repair for abdominal aortic aneurysm in the United States, 2001-2006
Age-related trends in utilization and outcome of open and endovascular repair for abdominal aortic aneurysm in the United States, 2001-2006
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DOI：
10.1016/j.jvs.2009.05.010
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发表时间：
2009-10-01
影响因子：
4.3
通讯作者：
Dale, William
中科院分区：
文献类型：
--
作者：
Schwarze, Margaret L.;Shen, Yang;Dale, William
目的：比较开放修补术(OAR)和腔内修补术(EVAR)治疗腹主动脉瘤(AAA)的疗效。方法：根据2001年至2006年全国住院患者的主要国际疾病分类第九次修订和临床修改(ICD-9-CM)的程序代码和完整的AAA的主要诊断代码，比较开放修补术(OAR)和腔内修补术(EVAR)在治疗腹主动脉瘤(AAA)中的应用和不同年龄组的疗效。采用加权最小二乘回归检验各年龄段的利用趋势。结果：在全国范围内，接受EVAR治疗的择期AAA的估计数量从2001年的11,171例增加到2006年的21,725例(P=.003)。在同一时期，使用OAR治疗的选择性AAA的数量从17,784例下降到8451例(P<；.001)。到2006年，对于所有年龄段的患者，EVAR比OAR更频繁地使用。与年轻年龄组相比，85岁的患者无症状AAA修复的总数显著增加，这几乎完全是由于EVAR的使用增加所致。与开放患者相比，EVAR患者的住院时间显著缩短(调整后的平均2.99天[95%可信区间(CI)，2.97-3.01]对8.78天[95%CI，8.53-8.57])，较低的住院死亡率(优势比[OR]，0.23；95%CI，0.19-0.28)，较少的住院并发症(OR，0.27；95%CI，0.25-0.28)，以及出院回家的可能性较高(OR，3.95；95%可信区间3.62-4.31)。对于年龄最大的患者来说，使用EVAR与OAR相比，并发症的减少最为显著。结论：随着接受AAA修复的患者的短期手术结果持续改善，选择性EVAR已取代OAR成为美国更常见的修复方法。这项技术的引入已经迅速被采用，特别是对于年龄最大的手术患者，年龄=85岁，他们以前可能没有为无症状的AAA提供手术干预。有必要进行进一步的调查，以研究这一趋势是否会改善这一老年人口的长期生存和生活质量。(《血管外科杂志》2009；50：722-9。)
Objective: This study used a large national administrative in-hospital database to compare utilization and age-specific outcomes between open repair (OAR) and endovascular (EVAR) repair for the treatment of abdominal aortic aneurysm (AAA).Methods: Discharges with the principal International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes for EVAR and OAR and principal diagnosis code of intact AAAs were selected from the 2001 to 2006 Nationwide Inpatient Sample (NIS). Weighted least-square regression was used to test the trend of utilization by age. Multiple linear and logistic regression analyses were used to assess the risk-adjusted outcomes.Results: Nationally, the estimated number of elective AAAs treated with EVAR increased from 11,171 in 2001 to 21,725 in 2006 (P = .003). The number of elective AAAs treated with OAR declined from 17,784 to 8451 during the same period (P < .001). By 2006, EVAR was more frequently used than OAR for patients of all ages. Compared with the younger age groups, patients aged >= 85 years had a significant increase in the total number of asymptomatic AAA repairs, driven almost entirely by an increase in the use of EVAR. Compared with open patients, EVAR patients had a significantly shorter length of hospitalization (adjusted mean, 2.99 days [95% confidence interval (CI), 2.97-3.01] vs 8.78 days [95% CI, 8.53-8.57]), less in-hospital mortality (odds ratio [OR], 0.23; 95% CI, 0.19-0.28), fewer in-hospital complications (OR, 0.27; 95% CI, 0.25-0.28), and a higher likelihood of being discharged to home (OR, 3.95; 95% CI, 3.62-4.31). The reduction of complications from the use of EVAR versus OAR was most dramatic for the oldest patients.Conclusions: As short-term surgical outcomes are consistently improving for patients undergoing AAA repair, elective EVAR has replaced OAR as the more common method of repair in the United States. The introduction of this technology has been rapidly adopted, particularly for the oldest-old surgical patients, aged >= 85 years, who previously may not have been offered surgical intervention for asymptomatic AAA. Further investigation is necessary to examine whether this trend improves the long-term survival and quality of life for this elderly population. (J Vasc Surg 2009;50:722-9.)