TY - JOUR
T1 - Treatment Outcome Trends for Non-Ruptured Abdominal Aortic Aneurysms
T2 - A Nationwide Prospective Cohort Study
AU - in collaboration with the Dutch Society of Vascular Surgery
AU - the Steering Committee of the Dutch Surgical Aneurysm Audit, and the Dutch Institute for Clinical Auditing
AU - Alberga, Anna J.
AU - Karthaus, Eleonora G.
AU - Wilschut, Janneke A.
AU - de Bruin, Jorg L.
AU - Akkersdijk, George P.
AU - Geelkerken, Robert H.
AU - Hamming, Jaap F.
AU - Wever, Jan J.
AU - Verhagen, Hence J.M.
AU - van den Akker, P. J.
AU - Akkersdijk, G. P.
AU - Akkersdijk, W. L.
AU - van Andringa de Kempenaer, M. G.
AU - Arts, C. H.P.
AU - Avontuur, A. M.
AU - Bakker, O. J.
AU - Balm, R.
AU - Barendregt, W. B.
AU - Bekken, J. A.
AU - Bender, M. H.M.
AU - Bendermacher, B. L.W.
AU - van den Berg, M.
AU - Beuk, R. J.
AU - Blankensteijn, J. D.
AU - Bode, A. S.
AU - Bodegom, M. E.
AU - van der Bogt, K. E.A.
AU - Boll, A. P.M.
AU - Booster, M. H.
AU - Borger van der Burg, B. L.S.
AU - de Borst, G. J.
AU - Bos-van Rossum, W. T.G.J.
AU - Bosma, J.
AU - Botman, J. M.J.
AU - Bouwman, L. H.
AU - Brehm, V.
AU - de Bruijn, M. T.
AU - de Bruin, J. L.
AU - Brummel, P.
AU - van Brussel, J. P.
AU - Buijk, S. E.
AU - Buimer, M. G.
AU - Buscher, H. C.J.L.
AU - Cancrinus, E.
AU - Castenmiller, P. H.
AU - Cazander, G.
AU - Cuypers, P. H.W.M.
AU - Daemen, J. H.C.
AU - Dawson, I.
AU - Mulder, W.
N1 - Publisher Copyright:
© 2021 The Author(s)
PY - 2022/2
Y1 - 2022/2
N2 - Objective: The Dutch Surgical Aneurysm Audit (DSAA) initiative was established in 2013 to monitor and improve nationwide outcomes of aortic aneurysm surgery. The objective of this study was to examine whether outcomes of surgery for intact abdominal aortic aneurysms (iAAA) have improved over time. Methods: Patients who underwent primary repair of an iAAA by standard endovascular (EVAR) or open surgical repair (OSR) between 2014 and 2019 were selected from the DSAA for inclusion. The primary outcome was peri-operative mortality trend per year, stratified by OSR and EVAR. Secondary outcomes were trends per year in major complications, textbook outcome (TbO), and characteristics of treated patients. The trends per year were evaluated and reported in odds ratios per year. Results: In this study, 11 624 patients (74.8%) underwent EVAR and 3 908 patients (25.2%) underwent OSR. For EVAR, after adjustment for confounding factors, there was no improvement in peri-operative mortality (aOR [adjusted odds ratio] 1.06, 95% CI 0.94 – 1.20), while major complications decreased (2014: 10.1%, 2019: 7.0%; aOR 0.91, 95% CI 0.88 – 0.95) and the TbO rate increased (2014: 68.1%, 2019: 80.9%; aOR 1.13, 95% CI 1.10 – 1.16). For OSR, the peri-operative mortality decreased (2014: 6.1%, 2019: 4.6%; aOR 0.89, 95% CI 0.82 – 0.98), as well as major complications (2014: 28.6%, 2019: 23.3%; aOR 0.95, 95% CI 0.91 – 0.99). Furthermore, the proportion of TbO increased (2014: 49.1%, 2019: 58.3%; aOR 1.05, 95% CI 1.01 – 1.10). In both the EVAR and OSR group, the proportion of patients with cardiac comorbidity increased. Conclusion: Since the establishment of this nationwide quality improvement initiative (DSAA), all outcomes of iAAA repair following EVAR and OSR have improved, except for peri-operative mortality following EVAR which remained unchanged.
AB - Objective: The Dutch Surgical Aneurysm Audit (DSAA) initiative was established in 2013 to monitor and improve nationwide outcomes of aortic aneurysm surgery. The objective of this study was to examine whether outcomes of surgery for intact abdominal aortic aneurysms (iAAA) have improved over time. Methods: Patients who underwent primary repair of an iAAA by standard endovascular (EVAR) or open surgical repair (OSR) between 2014 and 2019 were selected from the DSAA for inclusion. The primary outcome was peri-operative mortality trend per year, stratified by OSR and EVAR. Secondary outcomes were trends per year in major complications, textbook outcome (TbO), and characteristics of treated patients. The trends per year were evaluated and reported in odds ratios per year. Results: In this study, 11 624 patients (74.8%) underwent EVAR and 3 908 patients (25.2%) underwent OSR. For EVAR, after adjustment for confounding factors, there was no improvement in peri-operative mortality (aOR [adjusted odds ratio] 1.06, 95% CI 0.94 – 1.20), while major complications decreased (2014: 10.1%, 2019: 7.0%; aOR 0.91, 95% CI 0.88 – 0.95) and the TbO rate increased (2014: 68.1%, 2019: 80.9%; aOR 1.13, 95% CI 1.10 – 1.16). For OSR, the peri-operative mortality decreased (2014: 6.1%, 2019: 4.6%; aOR 0.89, 95% CI 0.82 – 0.98), as well as major complications (2014: 28.6%, 2019: 23.3%; aOR 0.95, 95% CI 0.91 – 0.99). Furthermore, the proportion of TbO increased (2014: 49.1%, 2019: 58.3%; aOR 1.05, 95% CI 1.01 – 1.10). In both the EVAR and OSR group, the proportion of patients with cardiac comorbidity increased. Conclusion: Since the establishment of this nationwide quality improvement initiative (DSAA), all outcomes of iAAA repair following EVAR and OSR have improved, except for peri-operative mortality following EVAR which remained unchanged.
KW - Abdominal aortic aneurysm
KW - Endovascular procedure
KW - Operative procedure
KW - Quality of care
KW - Treatment outcome
KW - Trends
UR - http://www.scopus.com/inward/record.url?scp=85122695805&partnerID=8YFLogxK
U2 - 10.1016/j.ejvs.2021.08.019
DO - 10.1016/j.ejvs.2021.08.019
M3 - Article
C2 - 35027275
AN - SCOPUS:85122695805
SN - 1078-5884
VL - 63
SP - 275
EP - 283
JO - European Journal of Vascular and Endovascular Surgery
JF - European Journal of Vascular and Endovascular Surgery
IS - 2
ER -