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Editor's Choice - The Impact of Centralisation and Endovascular Aneurysm Repair on Treatment of Ruptured Abdominal Aortic Aneurysms Based on International Registries

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Editor's Choice - The Impact of Centralisation and Endovascular Aneurysm Repair on Treatment of Ruptured Abdominal Aortic Aneurysms Based on International Registries. / Budtz-Lilly, Jacob; Björck, Martin; Venermo, Maarit; Debus, Sebastian; Behrendt, Christian-Alexander; Altreuther, Martin; Beiles, Barry; Szeberin, Zoltan; Eldrup, Nikolaj; Danielsson, Gudmundur; Thomson, Ian; Wigger, Pius; Khashram, Manar; Loftus, Ian; Mani, Kevin.

In: EUR J VASC ENDOVASC, Vol. 56, No. 2, 08.2018, p. 181-188.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Budtz-Lilly, J, Björck, M, Venermo, M, Debus, S, Behrendt, C-A, Altreuther, M, Beiles, B, Szeberin, Z, Eldrup, N, Danielsson, G, Thomson, I, Wigger, P, Khashram, M, Loftus, I & Mani, K 2018, 'Editor's Choice - The Impact of Centralisation and Endovascular Aneurysm Repair on Treatment of Ruptured Abdominal Aortic Aneurysms Based on International Registries', EUR J VASC ENDOVASC, vol. 56, no. 2, pp. 181-188. https://doi.org/10.1016/j.ejvs.2018.01.014

APA

Budtz-Lilly, J., Björck, M., Venermo, M., Debus, S., Behrendt, C-A., Altreuther, M., Beiles, B., Szeberin, Z., Eldrup, N., Danielsson, G., Thomson, I., Wigger, P., Khashram, M., Loftus, I., & Mani, K. (2018). Editor's Choice - The Impact of Centralisation and Endovascular Aneurysm Repair on Treatment of Ruptured Abdominal Aortic Aneurysms Based on International Registries. EUR J VASC ENDOVASC, 56(2), 181-188. https://doi.org/10.1016/j.ejvs.2018.01.014

Vancouver

Budtz-Lilly J, Björck M, Venermo M, Debus S, Behrendt C-A, Altreuther M et al. Editor's Choice - The Impact of Centralisation and Endovascular Aneurysm Repair on Treatment of Ruptured Abdominal Aortic Aneurysms Based on International Registries. EUR J VASC ENDOVASC. 2018 Aug;56(2):181-188. https://doi.org/10.1016/j.ejvs.2018.01.014

Bibtex

@article{f2670207f4474ce1a74b75c2733fa87f,
title = "Editor's Choice - The Impact of Centralisation and Endovascular Aneurysm Repair on Treatment of Ruptured Abdominal Aortic Aneurysms Based on International Registries",
abstract = "OBJECTIVES: Current management of ruptured abdominal aortic aneurysms (RAAA) varies among centres and countries, particularly in the degree of implementation of endovascular aneurysm repair (EVAR) and levels of vascular surgery centralisation. This study assesses these variations and the impact they have on outcomes.MATERIALS AND METHODS: RAAA repairs from vascular surgical registries in 11 countries, 2010-2013, were investigated. Data were analysed overall, per country, per treatment modality (EVAR or open aortic repair [OAR]), centre volume (quintiles IV), and whether centres were predominantly EVAR (≥50% of RAAA performed with EVAR [EVAR(p)]) or predominantly OAR [OAR(p)]. Primary outcome was peri-operative mortality. Data are presented as either mean values or percentages with 95% CI within parentheses, and compared with chi-square tests, as well as with adjusted OR.RESULTS: There were 9273 patients included. Mean age was 74.7 (74.5-74.9) years, and 82.7% of patients were men (81.9-83.6). Mean AAA diameter at rupture was 7.6 cm (7.5-7.6). Of these aneurysms, 10.7% (10.0-11.4) were less than 5.5 cm. EVAR was performed in 23.1% (22.3-24.0). There were 6817 procedures performed in OAR(p) centres and 1217 performed in EVAR(p) centres. Overall peri-operative mortality was 28.8% (27.9-29.8). Peri-operative mortality for OAR was 32.1% (31.0-33.2) and for EVAR 17.9% (16.3-19.6), p < .001, and the adjusted OR was 0.38 (0.31-0.47), p < .001. The peri-operative mortality was 23.0% in EVAR(p) centres (20.6-25.4), 29.7% in OAR(p) centres (28.6-30.8), p < .001; adjusted OR = 0.60 (0.46-0.78), p < .001. Peri-operative mortality was lower in the highest volume centres (QI > 22 repairs per year), 23.3% (21.2-25.4) than in QII-V, 30.0% (28.9-31.1), p < .001. Peri-operative mortality after OAR was lower in high volume centres compared with the other centres, 25.3% (23.0-27.6) and 34.0% (32.7-35.4), respectively, p < .001. There was no significant difference in peri-operative mortality after EVAR between centres based on volume.CONCLUSIONS: Peri-operative mortality is lower in centres with a primary EVAR approach or with high case volume. Most repairs, however, are still performed in low volume centres and in centres with a primary OAR strategy. Reorganisation of acute vascular surgical services may improve outcomes of RAAA repair.",
keywords = "Aged, Aortic Aneurysm, Abdominal/mortality, Aortic Rupture/mortality, Blood Vessel Prosthesis Implantation/mortality, Endovascular Procedures/mortality, Female, Humans, Male, Registries, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome",
author = "Jacob Budtz-Lilly and Martin Bj{\"o}rck and Maarit Venermo and Sebastian Debus and Christian-Alexander Behrendt and Martin Altreuther and Barry Beiles and Zoltan Szeberin and Nikolaj Eldrup and Gudmundur Danielsson and Ian Thomson and Pius Wigger and Manar Khashram and Ian Loftus and Kevin Mani",
note = "Copyright {\textcopyright} 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.",
year = "2018",
month = aug,
doi = "10.1016/j.ejvs.2018.01.014",
language = "English",
volume = "56",
pages = "181--188",
journal = "EUR J VASC ENDOVASC",
issn = "1078-5884",
publisher = "W.B. Saunders Ltd",
number = "2",

}

RIS

TY - JOUR

T1 - Editor's Choice - The Impact of Centralisation and Endovascular Aneurysm Repair on Treatment of Ruptured Abdominal Aortic Aneurysms Based on International Registries

AU - Budtz-Lilly, Jacob

AU - Björck, Martin

AU - Venermo, Maarit

AU - Debus, Sebastian

AU - Behrendt, Christian-Alexander

AU - Altreuther, Martin

AU - Beiles, Barry

AU - Szeberin, Zoltan

AU - Eldrup, Nikolaj

AU - Danielsson, Gudmundur

AU - Thomson, Ian

AU - Wigger, Pius

AU - Khashram, Manar

AU - Loftus, Ian

AU - Mani, Kevin

N1 - Copyright © 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

PY - 2018/8

Y1 - 2018/8

N2 - OBJECTIVES: Current management of ruptured abdominal aortic aneurysms (RAAA) varies among centres and countries, particularly in the degree of implementation of endovascular aneurysm repair (EVAR) and levels of vascular surgery centralisation. This study assesses these variations and the impact they have on outcomes.MATERIALS AND METHODS: RAAA repairs from vascular surgical registries in 11 countries, 2010-2013, were investigated. Data were analysed overall, per country, per treatment modality (EVAR or open aortic repair [OAR]), centre volume (quintiles IV), and whether centres were predominantly EVAR (≥50% of RAAA performed with EVAR [EVAR(p)]) or predominantly OAR [OAR(p)]. Primary outcome was peri-operative mortality. Data are presented as either mean values or percentages with 95% CI within parentheses, and compared with chi-square tests, as well as with adjusted OR.RESULTS: There were 9273 patients included. Mean age was 74.7 (74.5-74.9) years, and 82.7% of patients were men (81.9-83.6). Mean AAA diameter at rupture was 7.6 cm (7.5-7.6). Of these aneurysms, 10.7% (10.0-11.4) were less than 5.5 cm. EVAR was performed in 23.1% (22.3-24.0). There were 6817 procedures performed in OAR(p) centres and 1217 performed in EVAR(p) centres. Overall peri-operative mortality was 28.8% (27.9-29.8). Peri-operative mortality for OAR was 32.1% (31.0-33.2) and for EVAR 17.9% (16.3-19.6), p < .001, and the adjusted OR was 0.38 (0.31-0.47), p < .001. The peri-operative mortality was 23.0% in EVAR(p) centres (20.6-25.4), 29.7% in OAR(p) centres (28.6-30.8), p < .001; adjusted OR = 0.60 (0.46-0.78), p < .001. Peri-operative mortality was lower in the highest volume centres (QI > 22 repairs per year), 23.3% (21.2-25.4) than in QII-V, 30.0% (28.9-31.1), p < .001. Peri-operative mortality after OAR was lower in high volume centres compared with the other centres, 25.3% (23.0-27.6) and 34.0% (32.7-35.4), respectively, p < .001. There was no significant difference in peri-operative mortality after EVAR between centres based on volume.CONCLUSIONS: Peri-operative mortality is lower in centres with a primary EVAR approach or with high case volume. Most repairs, however, are still performed in low volume centres and in centres with a primary OAR strategy. Reorganisation of acute vascular surgical services may improve outcomes of RAAA repair.

AB - OBJECTIVES: Current management of ruptured abdominal aortic aneurysms (RAAA) varies among centres and countries, particularly in the degree of implementation of endovascular aneurysm repair (EVAR) and levels of vascular surgery centralisation. This study assesses these variations and the impact they have on outcomes.MATERIALS AND METHODS: RAAA repairs from vascular surgical registries in 11 countries, 2010-2013, were investigated. Data were analysed overall, per country, per treatment modality (EVAR or open aortic repair [OAR]), centre volume (quintiles IV), and whether centres were predominantly EVAR (≥50% of RAAA performed with EVAR [EVAR(p)]) or predominantly OAR [OAR(p)]. Primary outcome was peri-operative mortality. Data are presented as either mean values or percentages with 95% CI within parentheses, and compared with chi-square tests, as well as with adjusted OR.RESULTS: There were 9273 patients included. Mean age was 74.7 (74.5-74.9) years, and 82.7% of patients were men (81.9-83.6). Mean AAA diameter at rupture was 7.6 cm (7.5-7.6). Of these aneurysms, 10.7% (10.0-11.4) were less than 5.5 cm. EVAR was performed in 23.1% (22.3-24.0). There were 6817 procedures performed in OAR(p) centres and 1217 performed in EVAR(p) centres. Overall peri-operative mortality was 28.8% (27.9-29.8). Peri-operative mortality for OAR was 32.1% (31.0-33.2) and for EVAR 17.9% (16.3-19.6), p < .001, and the adjusted OR was 0.38 (0.31-0.47), p < .001. The peri-operative mortality was 23.0% in EVAR(p) centres (20.6-25.4), 29.7% in OAR(p) centres (28.6-30.8), p < .001; adjusted OR = 0.60 (0.46-0.78), p < .001. Peri-operative mortality was lower in the highest volume centres (QI > 22 repairs per year), 23.3% (21.2-25.4) than in QII-V, 30.0% (28.9-31.1), p < .001. Peri-operative mortality after OAR was lower in high volume centres compared with the other centres, 25.3% (23.0-27.6) and 34.0% (32.7-35.4), respectively, p < .001. There was no significant difference in peri-operative mortality after EVAR between centres based on volume.CONCLUSIONS: Peri-operative mortality is lower in centres with a primary EVAR approach or with high case volume. Most repairs, however, are still performed in low volume centres and in centres with a primary OAR strategy. Reorganisation of acute vascular surgical services may improve outcomes of RAAA repair.

KW - Aged

KW - Aortic Aneurysm, Abdominal/mortality

KW - Aortic Rupture/mortality

KW - Blood Vessel Prosthesis Implantation/mortality

KW - Endovascular Procedures/mortality

KW - Female

KW - Humans

KW - Male

KW - Registries

KW - Risk Assessment

KW - Risk Factors

KW - Time Factors

KW - Treatment Outcome

U2 - 10.1016/j.ejvs.2018.01.014

DO - 10.1016/j.ejvs.2018.01.014

M3 - SCORING: Journal article

C2 - 29482972

VL - 56

SP - 181

EP - 188

JO - EUR J VASC ENDOVASC

JF - EUR J VASC ENDOVASC

SN - 1078-5884

IS - 2

ER -