Short-term and long-term results of endovascular and open repair of abdominal aortic aneurysms in Germany

TY - JOUR

T1 - Short-term and long-term results of endovascular and open repair of abdominal aortic aneurysms in Germany

AU - Behrendt, Christian-Alexander

AU - Sedrakyan, Art

AU - Rieß, Henrik Christian

AU - Heidemann, Franziska

AU - Kölbel, Tilo

AU - Petersen, Jörg

AU - Debus, Eike Sebastian

N1 - Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

PY - 2017/12

Y1 - 2017/12

N2 - BACKGROUND: Endovascular aortic repair (EVAR) has emerged as a standard of care for abdominal aortic aneurysm (AAA) repair. However, real-world evidence to compare this technology to open aortic repair (OAR) is limited. Major gaps exist related to long-term outcomes of therapies worldwide.METHODS: Health insurance claims data of Germany's third largest insurance provider, DAK-Gesundheit, were used to determine outcomes after interventions for intact AAA (iAAA) and ruptured AAA (rAAA). The study included patients operated on between October 2008 and April 2015.RESULTS: Included were 5509 patients (3627 EVAR and 1859 OAR). Median follow-up was 2.44 years (range, 0-6.46 years). The in-hospital mortality was lower after EVAR compared with OAR for both iAAA (1.2% vs 5.4%) and rAAA (26.1% vs 42%; P < .001). Postoperative length of stay and occurrence of complications were also lower after EVAR. The in-hospital mortality benefits of EVAR were most prominent in octogenarians (iAAA: EVAR, 2.2%; OAR, 18.2%; rAAA: EVAR, 34.4%; OAR, 62.3%; P < .001). However, the early survival benefit after EVAR reversed at ∼1.5 years, and Cox proportional hazard models revealed no differences in overall survival between EVAR and OAR. Landmark analysis focusing on patients surviving the procedure has shown lower survival in patients with EVAR.CONCLUSIONS: In this largest European investigation to date using health insurance claims data, we found that in-hospital outcomes in Germany favor EVAR, which is comparable to findings reported in the United States and the United Kingdom. Trends toward lower long-term survival after EVAR after discharge are important and require future research and reflection.

AB - BACKGROUND: Endovascular aortic repair (EVAR) has emerged as a standard of care for abdominal aortic aneurysm (AAA) repair. However, real-world evidence to compare this technology to open aortic repair (OAR) is limited. Major gaps exist related to long-term outcomes of therapies worldwide.METHODS: Health insurance claims data of Germany's third largest insurance provider, DAK-Gesundheit, were used to determine outcomes after interventions for intact AAA (iAAA) and ruptured AAA (rAAA). The study included patients operated on between October 2008 and April 2015.RESULTS: Included were 5509 patients (3627 EVAR and 1859 OAR). Median follow-up was 2.44 years (range, 0-6.46 years). The in-hospital mortality was lower after EVAR compared with OAR for both iAAA (1.2% vs 5.4%) and rAAA (26.1% vs 42%; P < .001). Postoperative length of stay and occurrence of complications were also lower after EVAR. The in-hospital mortality benefits of EVAR were most prominent in octogenarians (iAAA: EVAR, 2.2%; OAR, 18.2%; rAAA: EVAR, 34.4%; OAR, 62.3%; P < .001). However, the early survival benefit after EVAR reversed at ∼1.5 years, and Cox proportional hazard models revealed no differences in overall survival between EVAR and OAR. Landmark analysis focusing on patients surviving the procedure has shown lower survival in patients with EVAR.CONCLUSIONS: In this largest European investigation to date using health insurance claims data, we found that in-hospital outcomes in Germany favor EVAR, which is comparable to findings reported in the United States and the United Kingdom. Trends toward lower long-term survival after EVAR after discharge are important and require future research and reflection.

KW - Administrative Claims, Healthcare

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Aortic Aneurysm, Abdominal/diagnostic imaging

KW - Blood Vessel Prosthesis Implantation/adverse effects

KW - Chi-Square Distribution

KW - Databases, Factual

KW - Endovascular Procedures/adverse effects

KW - Female

KW - Germany

KW - Hospital Mortality

KW - Humans

KW - Kaplan-Meier Estimate

KW - Length of Stay

KW - Male

KW - Multivariate Analysis

KW - Postoperative Complications/etiology

KW - Proportional Hazards Models

KW - Risk Factors

KW - Time Factors

KW - Treatment Outcome

U2 - 10.1016/j.jvs.2017.04.040

DO - 10.1016/j.jvs.2017.04.040

M3 - SCORING: Journal article

C2 - 28780975

VL - 66

SP - 1704

EP - 1711

JO - J VASC SURG

JF - J VASC SURG

SN - 0741-5214

IS - 6

ER -