Long-term survival and temporal trends in patient and surgeon factors after elective and ruptured abdominal aortic aneurysm surgery
Long-term survival and temporal trends in patient and surgeon factors after elective and ruptured abdominal aortic aneurysm surgery
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DOI：
10.1016/j.jvs.2004.02.021
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发表时间：
2004-06-01
影响因子：
4.3
通讯作者：
Laupacis, A
中科院分区：
文献类型：
--
作者：
Dueck, AD;Kucey, DS;Laupacis, A
目的：研究1993-1999年间安大略省所有接受腹主动脉瘤(AAAs)修补术或腹主动脉瘤破裂修补术的患者的记录，以确定外科医生或患者的情况是否发生变化，以及术后死亡率是否随时间变化。第二个目标是描述AAA手术后的长期存活率。方法：根据管理数据建立一个基于人群的回顾队列。外科医生的账单记录被用来识别在1993至1999年间进行的手术。使用CHI(2)和线性回归分析来确定变量是否随时间变化。结果：在研究期间，接受择期腹主动脉修补术的患者的年平均外科医生数量(P<；.0001)和接受血管外科医生手术的患者比例(P=0.02)都有所增加；接受腹主动脉破裂修补术的患者也有类似的趋势。无论是择期AAA修补术还是破裂AAA修补术，手术量与死亡率明显相关；然而，这种影响的益处并不大，超过了每年6~10次破裂性AAA修补术或20~30次选择性AAA修补术。在研究期间，30天的粗死亡率没有变化(择期AAA修补术4.5%，破裂AAAs修补术40.4%)。结论：尽管发现大容量血管外科医生越来越多地进行AAAs手术和选择性AAAs修补术，但在1993-1999年间早期死亡率没有变化。这可能是因为平均外科医生数量在研究开始时已经相对较高，这仅转化为对外科医生数量进一步增加的适度好处。
Objective: Records for all patients in Ontario who underwent elective repair of abdominal aortic aneurysms (AAAs) or repair of ruptured AAAs between 1993 and 1999 were studied to determine whether the profile of surgeons or patients changed and to determine whether postoperative mortality changed over time. The secondary objective was to describe long-term survival after AAA surgery.Methods: A population-based retrospective cohort was assembled from administrative data. Surgeon billing records were used to identify operations performed between 1993 and 1999. chi(2) and linear regression analyses were used to determine whether variables changed over time. Kaplan-Meier survival curves were used to estimate long-term survival.Results: For patients undergoing elective AAA repair, average annual surgeon volume (P < .0001) and proportion of patients operated on by vascular surgeons (P = .02) increased over the study period; similar trends were noted for patients undergoing repair of ruptured AAAs. Surgeon volume was clearly correlated with mortality after both elective AAA repair and repair of ruptured AAAs; however, the benefit of this effect was modest beyond a surgeon volume of 6 to 10 ruptured AAA repairs per year or 20 to 30 elective AAA repairs per year. No change in crude 30-day mortality (4.5% for elective AAA repair and 40.4% for repair of ruptured AAAs) was noted during the study.Conclusion: Despite the finding that surgery to repair ruptured AAAs and elective repair of AAAs is being increasingly performed by high-volume vascular surgeons, there was no change in early mortality between 1993 and 1999. This may have been because average surgeon volume was already relatively high at the beginning of the study period, which translated into only modest benefit to further increases in surgeon volume.