Comparison of long-term mortality after ruptured abdominal aortic aneurysm in England and Sweden

British Journal of Surgery - Tập 103 Số 3 - Trang 199-206 - 2016
Alan Karthikesalingam1, Anders Wanhainen2, Peter Holt1, Alberto Vidal‐Diez1, Jack Brownrigg1, Ilya Shpitser3, Martin Björck2, Matt Thompson1, Kevin Mani2
1St George's Vascular Institute, St George's University of London and St George's University Hospitals NHS Foundation Trust, London, UK
2Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
3Department of Mathematical Sciences, University of Southampton, Southampton, UK

Tóm tắt

Abstract Background Concern has been raised regarding international discrepancies in perioperative mortality after repair of ruptured abdominal aortic aneurysm (rAAA). The variation in in-hospital mortality is difficult to interpret, owing to international differences in discharge strategies. This study compared 90-day and 5-year mortality in patients who had a rAAA in England and Sweden. Methods Patients undergoing rAAA repair were identified from English Hospital Episode Statistics and the Swedish Vascular Registry (Swedvasc) between 2003 and 2012. Ninety-day and 5-year mortality were compared after matching for age and sex. Within-country analyses examined the impact of co-morbidity, teaching hospital status or hospital annual caseload, adjusted with causal inference techniques. Results Some 12 467 patients underwent rAAA repair in England, of whom 83·2 per cent were men; the median (i.q.r.) age was 75 (70–80) years. A total of 2829 Swedish patients underwent rAAA repair, of whom 81·3 per cent were men; their median (i.q.r.) age was 75 (69–80) years. The 90-day mortality rate was worse in England (44·0 per cent versus 33·4 per cent in Sweden; P < 0·001), as was 5-year mortality (freedom from mortality 38·6 versus 46·3 per cent respectively; P < 0·001). In England, lower mortality was seen in teaching hospitals with larger bed capacity, higher annual caseloads and greater use of endovascular aneurysm repair (EVAR). In Sweden, lower mortality was associated with EVAR, high annual caseload, or surgery on weekdays compared with weekends. Conclusion Short- and long-term mortality after rAAA repair was higher in England. In both countries, mortality was lowest in centres performing greater numbers of AAA repairs per annum, and more EVAR procedures.

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Tài liệu tham khảo

Sidloff, 2014, Aneurysm global epidemiology study: public health measures can further reduce abdominal aortic aneurysm mortality, Circulation, 129, 747, 10.1161/CIRCULATIONAHA.113.005457

Mani, 2011, Treatment of abdominal aortic aneurysm in nine countries 2005–2009: a Vascunet report, Eur J Vasc Endovasc Surg, 42, 598, 10.1016/j.ejvs.2011.06.043

Karthikesalingam, 2014, Mortality from ruptured abdominal aortic aneurysms: clinical lessons from a comparison of outcomes in England and the USA, Lancet, 383, 963, 10.1016/S0140-6736(14)60109-4

Mani, 2009, Improved long-term survival after abdominal aortic aneurysm repair, Circulation, 120, 201, 10.1161/CIRCULATIONAHA.108.832774

Holt, 2012, Multicentre study of the quality of a large administrative data set and implications for comparing death rates, Br J Surg, 99, 58, 10.1002/bjs.7680

Troëng, 2008, External validation of the Swedvasc registry: a first-time individual cross-matching with the unique personal identity number, Eur J Vasc Endovasc Surg, 36, 705, 10.1016/j.ejvs.2008.08.017

Lees, 2014, International Validation of Swedvasc, the Swedish National Registry for Vascular Surgery

Ozdemir, 2015, Association of hospital structures with mortality from ruptured abdominal aortic aneurysm, Br J Surg, 102, 516, 10.1002/bjs.9759

Armitage, 2010, Identifying co-morbidity in surgical patients using administrative data with the Royal College of Surgeons Charlson Score, Br J Surg, 97, 772, 10.1002/bjs.6930

Holt, 2012, Provider volume and long-term outcome after elective abdominal aortic aneurysm repair, Br J Surg, 99, 666, 10.1002/bjs.8696

Hernán, 2006, Instruments for causal inference: an epidemiologist's dream?, Epidemiology, 17, 360, 10.1097/01.ede.0000222409.00878.37

Robins, 1986, A new approach to causal inference in mortality studies with sustained exposure periods – application to control of the healthy worker survivor effect, Mathematical Modeling, 7, 1393, 10.1016/0270-0255(86)90088-6

Robins, 1992, Identifiability and exchangeability for direct and indirect effects, Epidemiology, 3, 143, 10.1097/00001648-199203000-00013

Baron, 1986, The moderator–mediator variable distinction in social psychology research: conceptual, strategic, and statistical considerations, J Person Soc Psychol, 51, 1173, 10.1037/0022-3514.51.6.1173

Pearl, 2001, Proceedings of the Seventeenth Conference on Uncertainty in Artificial Intelligence, 2001

Vascular Society of Great Britain and Ireland, 2009, Framework for Improving the Results of Elective AAA Repair

Holt, 2009, Effect of endovascular aneurysm repair on the volume–outcome relationship in aneurysm repair, Circ Cardiovasc Qual Outcomes, 2, 624, 10.1161/CIRCOUTCOMES.109.848465

Anjum, 2012, Explaining the decrease in mortality from abdominal aortic aneurysm rupture, Br J Surg, 99, 637, 10.1002/bjs.8698

Mani, 2013, Changes in the management of infrarenal abdominal aortic aneurysm disease in Sweden, Br J Surg, 100, 638, 10.1002/bjs.9046

Improve Trial Investigators, 2014, Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial, BMJ, 348, f7661, 10.1136/bmj.f7661

Edwards, 2014, Comparative effectiveness of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Medicare population, J Vasc Surg, 59, 575, 10.1016/j.jvs.2013.08.093

Holt, 2010, Propensity scored analysis of outcomes after ruptured abdominal aortic aneurysm, Br J Surg, 97, 496, 10.1002/bjs.6911

Park, 2013, Trends in treatment of ruptured abdominal aortic aneurysm: impact of endovascular repair and implications for future care, J Am Coll Surg, 216, 745, 10.1016/j.jamcollsurg.2012.12.028

Keil, 2014, The parametric g-formula for time-to-event data: intuition and a worked example, Epidemiology, 25, 889, 10.1097/EDE.0000000000000160

Karthikesalingam, 2013, The shortfall in long-term survival of patients with repaired thoracic or abdominal aortic aneurysms; retrospective case–control analysis of Hospital Episode Statistics, Eur J Vasc Endovasc Surg, 46, 533, 10.1016/j.ejvs.2013.09.008

Peppelenbosch, 2004, Diameter of abdominal aortic aneurysm and outcome of endovascular aneurysm repair: does size matter? A report from EUROSTAR, J Vasc Surg, 39, 288, 10.1016/j.jvs.2003.09.047

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British Journal of Surgery

Tập 103 Số 3

199-206

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