1
|
Pouncey AL, Meuli L, Lopez-Espada C, Budtz-Lilly J, Boyle JR, Behrendt CA, Mani K, Pherwani AD. Editor's Choice - Vascular Registries Contributing to VASCUNET Collaborative Abdominal Aortic Aneurysm Outcome Projects: A Scoping Review. Eur J Vasc Endovasc Surg 2024; 68:152-160. [PMID: 38697257 DOI: 10.1016/j.ejvs.2024.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/06/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVE Vascular surgery registries report on procedures and outcomes to promote patient safety and drive quality improvement. International registries have contributed significantly to the VASCUNET collaborative abdominal aortic aneurysm (AAA) outcome projects. This scoping review aimed to outline the national registries in vascular surgery that currently participate in the VASCUNET collaborative AAA projects. METHODS A scoping review of all published VASCUNET AAA studies and validation reports between 1997 and 2024 was undertaken. A survey was conducted among representatives of the international vascular registries contributing to VASCUNET collaborative AAA projects. RESULTS Currently, vascular registries from 10 countries (Australia, Denmark, Finland, Hungary, Iceland, New Zealand, Norway, Sweden, Switzerland, and the UK) contribute to the current VASCUNET collaborative AAA project, of which eight have national coverage. In the past, three countries (Germany, Malta, and Italy) have participated in previous VASCUNET AAA projects, and a further three countries (Serbia, Greece, and Portugal) have planned participation in future projects. External validity is high for all current registries, with most reporting rates of > 90%. The majority have internal validation processes to assess data accuracy. VASCUNET mediated validation has also been performed by the consortium for five countries to date (Hungary, Sweden, Denmark, Malta, and Switzerland), for which a high degree of external and internal validity was identified. Most registries have established mechanisms for data linkage with national administrative datasets or insurance claims datasets and contribute to quality improvement through regular reporting to participating centres. CONCLUSION National vascular registries from nations participating in the VASCUNET collaborative AAA projects are largely comprehensive, with high case ascertainment rates and good quality data with internal quality assurance. This provides a template for new registries wishing to join the VASCUNET collaboration and a benchmark for future research.
Collapse
Affiliation(s)
- Anna L Pouncey
- Vascular Department, Division of Surgery and Cancer, Imperial College London, London, UK
| | - Lorenz Meuli
- Department of Vascular Surgery, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland; Copenhagen Aortic Centre, Department of Vascular Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Cristina Lopez-Espada
- Department of Surgery, University Hospital Virgen de las Nieves, University of Granada, Granada, Spain
| | - Jacob Budtz-Lilly
- Division of Vascular Surgery, Department of Cardiovascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jonathan R Boyle
- Cambridge University Hospitals NHS Trust & Department of Surgery, University of Cambridge, Cambridge, UK
| | - Christian-Alexander Behrendt
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek, Asklepios Medical School, Hamburg, Germany
| | - Kevin Mani
- Department of Surgical Sciences, Section of Vascular surgery, Uppsala University, Uppsala, Sweden
| | - Arun D Pherwani
- Keele University School of Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK; The National Vascular Registry (NVR), UK.
| |
Collapse
|
2
|
Capó XF, García Reyes ME, Cánovas ÁS, Besalduch LS, Ruiz DF, Montoya SB. Hospital Volume of Elective Abdominal Aortic Aneurysm Repair as a Predictor of Mortality After Ruptured Abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2024; 68:30-38. [PMID: 38428671 DOI: 10.1016/j.ejvs.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/02/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Registry data suggest that centralising abdominal aortic aneurysm (AAA) surgery decreases the mortality rate after AAA repair. However, the impact of higher elective volumes on ruptured AAA (rAAA) repair associated mortality rates remains uncertain. This study aimed to examine associations between intact AAA (iAAA) repair volume and post-operative rAAA death. METHODS Using data from official national registries between 2015 - 2019, all iAAA and rAAA repairs were separately analysed across 10 public hospitals. The following were assessed: 30 day and 12 month mortality rate following open surgical repair (OSR) and endovascular aneurysm repair (EVAR). Associations between the 5 year hospital iAAA repair volumes (organised into tertiles) and rAAA associated mortality rate were analysed, regardless of treatment modality. Receiver operating characteristic (ROC) curves were generated to identify iAAA volume thresholds for decreasing the rAAA mortality rate. Subanalysis by treatment type was conducted. Threshold analysis was repeated with the Markov chain Monte Carlo (MCMC) procedure to confirm the findings. RESULTS A total of 1 599 iAAAs (80.2% EVAR, 19.8% OSR) and 196 rAAAs (66.3% EVAR, 33.7% OSR) repairs were analysed. The median and interquartile range of the volume/hospital/year for all iAAA repairs were 39.2 (31.2, 47.4). The top volume iAAA tertile exhibited lower rAAA associated 30 day (odds ratio [OR] 0.374; p = .007) and 12 month (OR 0.264; p < .001) mortality rates. The ROC analysis revealed a threshold of 40 iAAA repairs/hospital/year (EVAR + OSR) for a reduced rAAA mortality rate. Middle volume hospitals for open iAAA repair had reduced 30 day (OR 0.267; p = .033) and 12 month (OR 0.223; p = .020) mortality rates, with a threshold of five OSR procedures/year. The MCMC procedure found similar thresholds. No significant association was found between elective EVAR volumes and ruptured EVAR mortality. CONCLUSION Higher iAAA repair volumes correlated with a lower rAAA mortality rate, particularly for OSR. The recommended iAAA repair threshold is 40 procedures/year and five procedures/year for OSR. These findings support high elective volumes for improving the rAAA mortality rate, especially for OSR.
Collapse
Affiliation(s)
- Xavier Faner Capó
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departament de Cirurgia, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Marvin E García Reyes
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Álvaro Salinas Cánovas
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - David Flota Ruiz
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Sergi Bellmunt Montoya
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departament de Cirurgia, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| |
Collapse
|
3
|
Garland SK, Falster MO, Beiles CB, Freeman AJ, Jorm LR, Sedrakyan A, Sotade O, Varcoe RL. Long-Term Outcomes Following Elective Repair of Intact Abdominal Aortic Aneurysms: A Comparison Between Open Surgical and Endovascular Repair Using Linked Administrative and Clinical Registry Data. Ann Surg 2023; 277:e955-e962. [PMID: 35129507 DOI: 10.1097/sla.0000000000005259] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Compare long-term mortality, secondary intervention and secondary rupture following elective endovascular aneurysm repair (EVAR) and open surgical repair (OSR). BACKGROUND EVAR has surpassed OSR as the most common procedure used to repair abdominal aortic aneurysm (AAA), but evidence regarding long-term outcomes is inconclusive. METHODS We included patients in linked clinical registry and administrative data undergoing EVAR or OSR for intact AAA between January 2010 and June 2019. We used an inverse probability of treatment-weighted survival analysis to compare all-cause mortality, cause-specific mortality, secondary interventions and secondary rupture, and evaluate the impact of secondary interventions and secondary rupture on all-cause mortality. RESULTS The study included 3460 EVAR and 427 OSR patients. Compared to OSR, the EVAR all-cause mortality rate was lower in the first 30 days [adjusted hazard ratio (HR) = 0.22, 95% confidence interval (CI) 0.140.33], but higher between 1 and 4 years (HR = 1.29, 95% CI 1.12-1.48) and after 4years (HR = 1.41, 95% CI 1.23-1.63). Secondary intervention rates were higher over the first 30 days (HR = 2.26, 95% CI 1.11-4.59), but lower between 1 and 4years (HR = 0.59, 95% CI 0.48-0.74). Secondary aortic intervention rates were higher across the entire follow-up period (HR = 2.52, 95% CI 2.06-3.07). Secondary rupture rates did not differ significantly (HR = 1.06, 95% CI 0.73-1.55). All-cause mortality beyond 1 year remained significantly higher for EVAR after adjusting for any secondary interventions, or secendary rupture. CONCLUSIONS EVAR has an early survival benefit compared to OSR. However, elevated long-term mortality and higher rates of secondary aortic interventions and subsequent aneurysm repair suggest that EVAR may be a less durable method of aortic aneurysm exclusion.
Collapse
Affiliation(s)
- Sarah K Garland
- Center for Big Data Research in Health, UNSW Sydney, Australia
- Biostatistics Training Program, NSW Ministry of Health, Sydney, Australia
| | | | | | | | - Louisa R Jorm
- Center for Big Data Research in Health, UNSW Sydney, Australia
| | - Art Sedrakyan
- Healthcare Policy and Research, Weill Cornell Medicine, New York, NY
| | | | - Ramon L Varcoe
- Department of Surgery, Prince of Wales Hospital
- Faculty of Medicine, University of New South Wales
- The Vascular Institute, Prince of Wales Hospital, Sydney, Australia
| |
Collapse
|
4
|
El Gamel A. Aortic-Size Paradox: Reducing the Threshold for Intervention Will Help to Save Some Lives But We Still Need Noah to Predict the Flood. Heart Lung Circ 2023; 32:279-283. [PMID: 36958870 DOI: 10.1016/j.hlc.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Affiliation(s)
- Adam El Gamel
- Wollongong Cardiothoracic Unit, Wollongong, NSW, Australia; Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; and, University of Waikato Medical Research Centre, The University of Waikato, Hamilton, New Zealand.
| |
Collapse
|
5
|
Falster MO, Garland SK, Jorm LR, Beiles CB, Freeman AJ, Sedrakyan A, Sotade OT, Varcoe RL. Editor's Choice - Comparison of Outcomes for Major Contemporary Endograft Devices Used for Endovascular Repair of Intact Abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2023; 65:272-280. [PMID: 36334901 DOI: 10.1016/j.ejvs.2022.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 09/23/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare rates of mortality, rupture, and secondary intervention following endovascular repair (EVAR) of intact abdominal aortic aneurysms (AAA) using contemporary endograft devices from three major manufacturers. METHODS This was a retrospective cohort study using linked clinical registry (Australasian Vascular Audit) and all payer administrative data. Patients undergoing EVAR for intact AAA between 2010 and 2019 in New South Wales, Australia were identified. Rates of all cause death, secondary rupture, and secondary intervention (subsequent aneurysm repair; other secondary aortic intervention) were compared for patients treated with Cook, Medtronic, and Gore standard devices. Inverse probability of treatment weighted proportional hazards and competing risk regression were used to adjust for patient, clinical, and aneurysm characteristics, using Cook as the referent device. RESULTS This study identified 2 874 eligible EVAR patients, with a median follow up of 4.1 (maximum 9.5) years. Mortality rates were similar for patients receiving different devices (ranging between 7.0 and 7.3 per 100 person years). There was no statistically significant difference between devices in secondary rupture rates, which ranged between 0.4 and 0.5 per 100 person years. Patients receiving Medtronic and Gore devices tended to have higher crude rates of subsequent aneurysm repair (1.5 per 100 person years) than patients receiving Cook devices (0.8 per 100 person years). This finding remained in the adjusted analysis, but was only statistically significant for Medtronic devices (HR 1.57, 95% CI 1.02 - 2.47; HR 1.73, 95% CI 0.94 - 3.18, respectively). CONCLUSION Major endograft devices have similar overall long term safety profiles. However, there may be differences in rates of secondary intervention for some devices. This may reflect endograft durability, or patient selection for different devices based on aneurysm anatomy. Continuous comparative assessments are needed to guide evidence for treatment decisions across the range of available devices.
Collapse
Affiliation(s)
| | - Sarah K Garland
- Centre for Big Data Research in Health, UNSW Sydney, Australia; Biostatistics Training Program, NSW Ministry of Health, Sydney, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health, UNSW Sydney, Australia
| | - C Barry Beiles
- Australian and New Zealand Society for Vascular Surgery, East Melbourne, Australia
| | - Anthony J Freeman
- Australian and New Zealand Society for Vascular Surgery, East Melbourne, Australia
| | - Art Sedrakyan
- Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | | | - Ramon L Varcoe
- Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, UNSW Sydney, Australia; The Vascular Institute, Prince of Wales Hospital, Sydney, Australia
| |
Collapse
|
6
|
Mees BM, Verhagen HJ. Towards Society Regulated Regionalisation of Aortic Aneurysm Surgery in The Netherlands. Eur J Vasc Endovasc Surg 2022; 64:441-443. [PMID: 36270498 DOI: 10.1016/j.ejvs.2022.10.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/29/2022] [Accepted: 10/13/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Barend Me Mees
- Department of Vascular Surgery, Maastricht UMC, Maastricht, the Netherlands.
| | - Hence Jm Verhagen
- Department of Vascular Surgery, Erasmus MC, Rotterdam, the Netherlands
| |
Collapse
|
7
|
Teraa M, Hazenberg CEVB. The Current Era of Endovascular Aortic Interventions and What the Future Holds. J Clin Med 2022; 11:jcm11195900. [PMID: 36233768 PMCID: PMC9573386 DOI: 10.3390/jcm11195900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Martin Teraa
- Correspondence: ; Tel.: +31-887556965; Fax: +31-887555017
| | | |
Collapse
|
8
|
Yamabe T, Zhao Y, Kurlansky PA, Patel V, George I, Smith CR, Takayama H. Extent of aortic replacement and operative outcome in open proximal thoracic aortic aneurysm repair. JTCVS OPEN 2022; 12:1-12. [PMID: 36590741 PMCID: PMC9801234 DOI: 10.1016/j.xjon.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/30/2022] [Accepted: 07/11/2022] [Indexed: 01/04/2023]
Abstract
Objectives There are few data to delineate the risk differences among open aortic procedures. We aimed to investigate the influence of the procedural types on the outcomes of proximal thoracic aortic aneurysm repair. Methods Among 1900 patients who underwent aortic replacement in our institution between 2005 and 2019, 1132 patients with aortic aneurysm who underwent a graft replacement of proximal thoracic aorta were retrospectively reviewed. Patients were divided into 4 groups based on the extent of the aortic replacement: isolated ascending aortic replacement (n = 52); ascending aortic replacement with distal extension with hemiarch, partial arch, or total arch replacement (n = 126); ascending aortic replacement with proximal extension with aortic valve or root replacement (n = 620); and ascending aortic replacement with distal and proximal extension (n = 334). "Eventful recovery," defined as occurrence of any key complications, was used as the primary end point. Odds ratios for inability to achieve uneventful recovery in each procedure were calculated using ascending aortic replacement as a reference. Results Overall, in-hospital mortality and stroke occurred in 16 patients (1.4%) and 24 patients (2.1%). Eventful recovery was observed in 19.7% of patients: 11.5% in those with ascending aortic replacement, 36.5% in those with partial arch or total arch replacement, 16.6% in those with proximal extension with aortic valve or root replacement, and 20.4% in those with distal and proximal extension (P < .001). With ascending aortic replacement as the reference, a multivariable logistic regression revealed partial arch or total arch replacement (odds ratio, 10.0; 95% confidence interval, 1.8-189.5) was an independent risk factor of inability to achieve uneventful recovery. Conclusions Open proximal aneurysm repair in the contemporary era resulted in satisfactory in-hospital outcomes. Distal extension was associated with a higher risk for postoperative complications.
Collapse
Affiliation(s)
- Tsuyoshi Yamabe
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY,Department of Cardiovascular Surgery, Shonan-Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Yanling Zhao
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Paul A. Kurlansky
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Virendra Patel
- Division of Aortic Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Isaac George
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Craig R. Smith
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Hiroo Takayama
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY,Address for reprints: Hiroo Takayama, MD, PhD, Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, 177 Fort Washington Ave, New York, NY 10032.
| |
Collapse
|
9
|
Borzsák S, Süvegh A, Szentiványi A, Fontanini DM, Vecsey-Nagy M, Banga P, Sótonyi P, Szeberin Z, Csobay-Novák C. Midterm Results of Iliac Branch Devices in a Newly Established Aortic Center. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081154. [PMID: 36013332 PMCID: PMC9409818 DOI: 10.3390/life12081154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022]
Abstract
The first-line treatment of common iliac artery aneurysms is endovascular repair. International guidelines recommend the preservation of the internal iliac artery, which is best achieved by the implantation of an iliac bifurcation device (IBD). Our aim was to evaluate the initial midterm results of IBDs in the leading vascular center of Hungary. In this single-center retrospective study, relevant clinical data and the results of the imaging examinations were collected and analyzed in all patients who underwent IBD implantation between December 2010 and July 2021. Thirty-five patients (31 males, mean age: 67.9 ± 8.5 years) underwent endovascular treatment with 37 IBD implantations. Technical success was achieved in 88.2% of the patients, with no perioperative mortality or open surgical conversion. One patient was lost during follow-up. Internal iliac artery occlusion was detected in three (8.8%) patients, and reintervention was performed in five (14.7%) patients. Primary patency of the internal iliac branch was 97.1% at 1 month, 93% at 2 months, and 89.0% at 5 years. The average follow-up time was 20.1 ± 26.2 months, during which two (5.9%) deaths occurred. Our initial experience with iliac branch devices was associated with a low complication rate and a favorable outcome, which confirms the midterm success of this intervention.
Collapse
Affiliation(s)
- Sarolta Borzsák
- Department of Interventional Radiology, Semmelweis University, 1122 Budapest, Hungary; (S.B.); (A.S.); (A.S.); (D.M.F.); (M.V.-N.)
- Semmelweis Aortic Center, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (P.B.); (P.S.); (Z.S.)
| | - András Süvegh
- Department of Interventional Radiology, Semmelweis University, 1122 Budapest, Hungary; (S.B.); (A.S.); (A.S.); (D.M.F.); (M.V.-N.)
| | - András Szentiványi
- Department of Interventional Radiology, Semmelweis University, 1122 Budapest, Hungary; (S.B.); (A.S.); (A.S.); (D.M.F.); (M.V.-N.)
| | - Daniele Mariastefano Fontanini
- Department of Interventional Radiology, Semmelweis University, 1122 Budapest, Hungary; (S.B.); (A.S.); (A.S.); (D.M.F.); (M.V.-N.)
- Semmelweis Aortic Center, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (P.B.); (P.S.); (Z.S.)
| | - Milán Vecsey-Nagy
- Department of Interventional Radiology, Semmelweis University, 1122 Budapest, Hungary; (S.B.); (A.S.); (A.S.); (D.M.F.); (M.V.-N.)
| | - Péter Banga
- Semmelweis Aortic Center, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (P.B.); (P.S.); (Z.S.)
- Department of Vascular and Endovascular Surgery, Semmelweis University, 1122 Budapest, Hungary
| | - Péter Sótonyi
- Semmelweis Aortic Center, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (P.B.); (P.S.); (Z.S.)
- Department of Vascular and Endovascular Surgery, Semmelweis University, 1122 Budapest, Hungary
| | - Zoltán Szeberin
- Semmelweis Aortic Center, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (P.B.); (P.S.); (Z.S.)
- Department of Vascular and Endovascular Surgery, Semmelweis University, 1122 Budapest, Hungary
| | - Csaba Csobay-Novák
- Department of Interventional Radiology, Semmelweis University, 1122 Budapest, Hungary; (S.B.); (A.S.); (A.S.); (D.M.F.); (M.V.-N.)
- Semmelweis Aortic Center, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (P.B.); (P.S.); (Z.S.)
- Correspondence: ; Tel.: +36-1-458-6870
| |
Collapse
|
10
|
Alhajri N, Yin K, Locham S, Ou M, Malas M. Low Volume Hospitals Are Not Associated with Inferior Outcomes After Thoracic Endovascular Aortic Repair. J Vasc Surg 2021; 75:1202-1210. [PMID: 34848350 DOI: 10.1016/j.jvs.2021.11.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 11/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Thoracic endovascular aortic repair (TEVAR) has been used increasingly to treat complex thoracic aortic pathology. This study aimed to assess hospital volume's impact on outcomes in patients undergoing TEVAR. STUDY DESIGN Patients undergoing TEVAR between January 2015 and December 2019 were identified in the Vascular Quality Initiative (VQI) database. The participating centers were grouped into either low-volume hospitals (LVH) or high-volume hospitals (HVH). We assessed the impact of hospital volume on 30-day mortality and major postoperative complications using a multivariable logistic regression analysis. RESULTS A total of 3,584 TEVAR patients (asymptomatic = 1,720; symptomatic/ruptured =1,864) were identified at 147 centers. The median average annual number of TEVAR cases at LVH and HVH was 6 and 17 cases, respectively. There was no significant difference in 30-day mortality between LVH and HVH (asymptomatic: 3.7% vs. 3.7%, p = 0.98; symptomatic/rupture: 9.3% vs. 7.3%, p = 0.13). After adjusting for multiple clinical and anatomical factors, being treated in LVH was not associated with increased 30-day mortality (asymptomatic: OR = 0.98, 95% CI: 0.52, 1.87, p = 0.96; symptomatic/rupture: OR = 1.15, 95%CI: 0.75, 1.77, p = 0.53) nor an increased risk of major complications, including renal, neurological, cardiac, pulmonary, and femoral artery access complication (all p > 0.05). CONCLUSION Using a large national database, we demonstrate that LVH is not associated with inferior TEVAR outcomes than HVH. The technical aspect of the procedure might play a role in the similarity of outcomes across the different institutional experiences.
Collapse
Affiliation(s)
- Noora Alhajri
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates; Department of Surgery, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, United Arab Emirates
| | - Kanhua Yin
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Satinderjit Locham
- Division of Vascular and Endovascular Surgery, University of California, San Diego, La Jolla, California
| | - Michael Ou
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mahmoud Malas
- Division of Vascular and Endovascular Surgery, University of California, San Diego, La Jolla, California.
| |
Collapse
|
11
|
Kolh P, Verhagen HJM. The ESVS Guidelines Provide a Solid Scientific Basis to Treat Patients with an Abdominal Aorto-iliac Aneurysm in Europe and Beyond. Eur J Vasc Endovasc Surg 2021; 62:845-846. [PMID: 34736845 DOI: 10.1016/j.ejvs.2021.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/11/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Philippe Kolh
- ESVS Guidelines Steering Committee Chairman, ESVS Deputy President Elect, Department of Biomedical and Preclinical Sciences, University of Liège, Belgium.
| | - Hence J M Verhagen
- ESVS President, Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| |
Collapse
|
12
|
Lin JC, Welle N, Ding J, Chuen J. A look to the future: Pandemic-induced digital technologies in vascular surgery. Semin Vasc Surg 2021; 34:139-151. [PMID: 34642034 PMCID: PMC8502076 DOI: 10.1053/j.semvascsurg.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 02/03/2023]
Abstract
Like many areas of medicine, vascular surgery has been transformed by the COVID-19 (coronavirus disease 2019) pandemic. Public health precautions to minimize disease transmission have led to reduced attendance at hospitals and clinics in elective and emergency settings; fewer face-to-face and hands-on clinical interactions; and increased reliance on telemedicine, virtual attendance, investigations, and digital therapeutics. However, a “silver lining” to the COVID-19 pandemic may be the mainstream acceptance and acceleration of telemedicine, remote monitoring, digital health technology, and three-dimensional technologies, such as three-dimensional printing and virtual reality, by connecting health care providers to patients in a safe, reliable, and timely manner, and supplanting face-to-face surgical simulation and training. This review explores the impact of these changes in the delivery of vascular surgical care.
Collapse
Affiliation(s)
- Judith C Lin
- Michigan State University College of Human Medicine 4660 S. Hagadorn Rd. Ste. #600 East Lansing, MI 48823.
| | - Nicholas Welle
- Michigan State University College of Osteopathic Medicine, Lansing, MI
| | - Joel Ding
- Austin Health Department of Surgery, The University of Melbourne, Heidelberg, Australia
| | - Jason Chuen
- Austin Health Department of Surgery, The University of Melbourne, Heidelberg, Australia
| |
Collapse
|
13
|
Association between Hospital Volume and Failure to Rescue after Open or Endovascular Repair of Intact Abdominal Aortic Aneurysms in the VASCUNET and International Consortium of Vascular Registries. Ann Surg 2021; 274:e452-e459. [PMID: 34225297 DOI: 10.1097/sla.0000000000005044] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the association between hospital volume and failure to rescue (FtR), after open (OAR) and endovascular (EVAR) repair of intact abdominal aortic aneurysms (AAA) among centers participating in the VASCUNET and International Consortium of Vascular Registries (ICVR). SUMMARY BACKGROUND DATA FtR (i.e., in-hospital death following major complications) is a composite end-point representing the inability to treat complications effectively and prevent death. METHODS Using data from eight vascular registries, complication and mortality rates after intact AAA repair were examined (n = 60,273; EVAR-43,668; OAR-16,605). A restricted analysis using pooled data from four countries (Australia, Hungary, New Zealand, USA) reporting data on all postoperative complications (bleeding, stroke, cardiac, respiratory, renal, colonic ischemia) was performed to identify risk-adjusted association between hospital volume and FtR. RESULTS The most frequently reported complications were cardiac (EVAR-3.0%, OAR-8.9%) and respiratory (EVAR-1.0%, OAR-5.7%). In adjusted analysis, 4.3% of EVARs and 18.5% of OARs had at least one complication. The overall FtR rate was 10.3% after EVAR and 15.7% after OAR. Subjects treated in the highest volume centers(Q4) had 46% and 80% lower odds of FtR after EVAR (OR = 0.54; 95%CI = 0.34-0.87;p = 0.04) and OAR (OR = 0.22; 95%CI = 0.11-0.44;p < 0.001) when compared to lowest volume centers(Q1), respectively. Colonic ischemia had the highest risk of FtR for both procedures (adjusted predicted risks, EVAR: 27%, 95%CI 14%-45%; OAR: 30%, 95%CI 17%-46%). CONCLUSIONS In this multi-national dataset, FtR rate after intact AAA repair with EVAR and OAR is significantly associated with hospital volume. Hospitals in the top volume quartiles achieve the lowest mortality after a complication has occurred.
Collapse
|
14
|
Qin KR, Perera M, Papa N, Mitchell D, Chuen J. Open versus Endovascular Abdominal Aortic Aneurysm Repair in the Australian Private Sector Over Twenty Years. J Endovasc Ther 2021; 28:844-851. [PMID: 34212777 DOI: 10.1177/15266028211028215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE Over the past two decades, the proliferation of endovascular surgery has changed the approach to abdominal aortic aneurysm (AAA) repair. In Australia, close to two-thirds of surgical procedures are performed in the private healthcare system. We aimed to describe the trends in AAA repair in the Australian private sector throughout the early 21st century. MATERIALS AND METHODS Medicare Benefits Schedule (MBS) statistics were accessed to determine the number of infrarenal open AAA repair (OAR) and endovascular AAA repair (EVAR) procedures performed between January 2000 and December 2019. Population data were extracted from the Australian Bureau of Statistics and used to calculate incidence per 100,000 population. Further analysis was performed according to age, gender, and state. RESULTS During the study period, 13,193 (67.0%) EVARs and 6504 (33.0%) OARs were performed in the Australian private sector. OARs fell from 70.5% (n=567) of AAA repairs in 2000 to 15.7% (n=237) in 2019, while EVARs rose from 29.5% (n=151) to 84.3% (n=808). The frequency of EVAR surpassed OAR in 2004. The overall incidence of AAA repair varied minimally over the time period (range: 4.9-6.5 per 100,000 adults per year). AAA repair was more common in males than females (9.7 vs 1.7 per 100,000 population) and more common in older age groups. There was a 4-fold increase in EVAR among males older than 85 years (12.8-57.4 per 100,000 population), the largest rise of any group. The overall EVAR:OAR ratio increased from 0.4 to 5.4. There were considerable state-based discrepancies. CONCLUSION The landscape of AAA repair in Australian private sector has drastically changed with a clear preference toward EVAR. EVAR saw increased use across all genders, age groups and states, despite stable rates of AAA surgery. Further research is necessary to compare our findings to national trends in the Australian public sector.
Collapse
Affiliation(s)
- Kirby R Qin
- Department of Vascular Surgery, Austin Health, Heidelberg, Victoria, Australia.,Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Marlon Perera
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia.,Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
| | - Nathan Papa
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Mitchell
- Department of Vascular Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Jason Chuen
- Department of Vascular Surgery, Austin Health, Heidelberg, Victoria, Australia.,Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
15
|
Iyengar A, Goel NJ, Kelly JJ, Han J, Brown CR, Khurshan F, Chen Z, Desai ND. Predictors of 30-day readmission and resource utilization after thoracic endovascular aortic repair. Eur J Cardiothorac Surg 2021; 58:574-582. [PMID: 32386207 DOI: 10.1093/ejcts/ezaa128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/01/2020] [Accepted: 02/04/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The introduction and expansion of thoracic endovascular aortic repair (TEVAR) have revolutionized the treatment of a variety of thoracic aortic diseases. We sought to evaluate the incidence, causes, predictors and costs associated with 30-day readmission after TEVAR in a nationally representative cohort. METHODS Adult patients undergoing isolated TEVAR were identified in the National Readmissions Database from 2010 to 2014. Hospital costs were estimated by converting individual hospital charge data adjusted to 2014 consumer price indices. Multivariable logistic regression was utilized to determine hospital- and patient-level factors associated with readmissions. RESULTS A total of 24 983 TEVARs were noted during the study period; the average age of the patients was 65 ± 16 years; 40% were women. The most common indication was an intact thoracic aneurysm (43.5%), followed by aortic dissection (30.5%). The average cost of the index admission was $63 644 ± $52 312; the average hospital stay was 11 ± 14 days; the index mortality rate was 6.7%. Readmissions within 30 days occurred in 17.4% of patients. Indications for readmission were varied; the most common aetiologies were cardiac (17.8%), infectious (16.0%) and pulmonary (12.1%). On multivariable analysis, the strongest predictor of readmission was the diagnosis, with a ruptured thoraco-abdominal aneurysm having the highest readmission burden (adjusted odds ratio 2.23, 1.17-4.24; P = 0.015). Notably, hospital volume did not predict index hospital length of stay, costs or 30-day readmissions (all P > 0.10). CONCLUSIONS Annual TEVAR volume was not associated with any of the outcomes assessed. Rather, indication for TEVAR was the strongest predictor for many outcomes. As TEVAR becomes increasingly utilized, a focus on cardiac and vascular diseases may reduce readmissions and improve quality of care.
Collapse
Affiliation(s)
- Amit Iyengar
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Nicholas J Goel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John J Kelly
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason Han
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Chase R Brown
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Fabliha Khurshan
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Zehang Chen
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
16
|
Boyle JR, Mao J, Beck AW, Venermo M, Sedrakyan A, Behrendt CA, Szeberin Z, Eldrup N, Schermerhorn M, Beiles B, Thomson I, Cassar K, Altreuther M, Debus S, Johal AS, Waton S, Scali ST, Cromwell DA, Mani K. Editor's Choice - Variation in Intact Abdominal Aortic Aneurysm Repair Outcomes by Country: Analysis of International Consortium of Vascular Registries 2010 - 2016. Eur J Vasc Endovasc Surg 2021; 62:16-24. [PMID: 34144883 DOI: 10.1016/j.ejvs.2021.03.034] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 03/17/2021] [Accepted: 03/31/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Outcomes for intact abdominal aortic aneurysm (AAA) repair vary over time and by healthcare system, country, and surgeon. The aim of this study was to analyse peri-operative mortality for intact AAA repair in 11 countries over time and compare outcomes by gender, age, and geographical location. METHODS Prospective data on primary repair of intact AAA were collected from 11 countries through the International Consortium of Vascular Registries (ICVR) and analysed for two time periods, 2010 - 2013 and 2014 - 2016. The primary outcome was peri-operative mortality after endovascular aneurysm repair (EVAR) and open surgical repair (OSR). Multivariable logistic regression models were used to adjust for differences in patient characteristics. RESULTS A total of 103 715 patients were included. The percentage of patients undergoing EVAR increased from 63.6% to 71.2% (p < .001) over the study period. This proportion varied by country from 35% in Hungary to 81% in the United States. Overall peri-operative mortality decreased from 2.1% to 1.6 % (p < .001). Mortality also declined significantly over time for both OSR 4.2% to 3.6 % (p = .002) and EVAR 1.0% to 0.7% (p = .002). Mortality was significantly higher for female than male patients (3.0% vs. 1.6% p < .001). The percentage of patients > 80 years old undergoing AAA repair remained constant at 23.6% (p = .91). Peri-operative mortality was higher for patients > 80 years than for those < 80 years old (2.7% vs. 1.6% p < .001). Forty-six per cent (n = 275) of all EVAR deaths occurred in the over 80s. CONCLUSION The proportion of AAA repairs performed using EVAR has increased over time. Peri-operative mortality continues to decline for both OSR and EVAR. Outcomes however were significantly worse for both women and those aged over 80, so efforts should be focused on these patient groups to further reduce elective AAA mortality rates.
Collapse
Affiliation(s)
- Jonathan R Boyle
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Trust & Department of Surgery, University of Cambridge, Cambridge, UK.
| | - Jialin Mao
- Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maarit Venermo
- Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Art Sedrakyan
- Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Christian-Alexander Behrendt
- Department of Vascular Medicine, Working Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Zoltan Szeberin
- Department of Vascular Surgery, Semmelweis University, Budapest, Hungary
| | - Nikolaj Eldrup
- Department of Vascular Surgery, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Marc Schermerhorn
- Division of Vascular Surgery and Endovascular Therapy, Beth Israel Deaconess Medical Centre, Boston, MA, USA
| | - Barry Beiles
- Australasian Vascular Audit, Australasian Society for Vascular Surgery, Melbourne, Australia
| | - Ian Thomson
- Department of Surgery, University of Otago, Dunedin, New Zealand
| | - Kevin Cassar
- Department of Surgery, Faculty of Medicine and Surgery, University of Malta, Malta
| | - Martin Altreuther
- Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Sebastian Debus
- Department of Vascular Medicine, Working Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Amundeep S Johal
- The Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, United Kingdom
| | - Sam Waton
- The Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, United Kingdom
| | - Salvatore T Scali
- University of Florida College of Medicine, Division of Vascular Surgery & Endovascular Therapy, Gainesville, FL, USA
| | - David A Cromwell
- The Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, United Kingdom
| | - Kevin Mani
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
17
|
Wanhainen A, Haulon S, Kolh P. Centralisation of Abdominal Aortic Aneurysm Repair - We Can No Longer Ignore the Benefits! Eur J Vasc Endovasc Surg 2020; 60:500-501. [DOI: 10.1016/j.ejvs.2020.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/27/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
|
18
|
Nikol S, Mathias K, Olinic DM, Blinc A, Espinola-Klein C. Aneurysms and dissections - What is new in the literature of 2019/2020 - a European Society of Vascular Medicine annual review. VASA 2020; 49:1-36. [PMID: 32856993 DOI: 10.1024/0301-1526/a000865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
More than 6,000 publications were found in PubMed concerning aneurysms and dissections, including those Epub ahead of print in 2019, printed in 2020. Among those publications 327 were selected and considered of particular interest.
Collapse
Affiliation(s)
- Sigrid Nikol
- Department of Angiology, ASKLEPIOS Klinik St. Georg, Hamburg, Germany.,University of Münster, Germany
| | - Klaus Mathias
- World Federation for Interventional Stroke Treatment (WIST), Hamburg, Germany
| | - Dan Mircea Olinic
- Medical Clinic No. 1, University of Medicine and Pharmacy and Interventional Cardiology Department, Emergency Hospital, Cluj-Napoca, Romania
| | - Aleš Blinc
- Department of Vascular Diseases, University Medical Centre Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Slovenia
| | | |
Collapse
|
19
|
Gray WK, Day J, Horrocks M. Editor's Choice - Volume-Outcome Relationships in Elective Abdominal Aortic Aneurysm Surgery: Analysis of the UK Hospital Episodes Statistics Database for the Getting It Right First Time (GIRFT) Programme. Eur J Vasc Endovasc Surg 2020; 60:509-517. [PMID: 32807679 DOI: 10.1016/j.ejvs.2020.07.069] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/29/2020] [Accepted: 07/21/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To investigate whether a volume-outcome relationship exists for elective abdominal aortic aneurysm (AAA) surgery conducted within the National Health Service (NHS) in England. METHODS This was an analysis of administrative data. Data were extracted from the Hospital Episodes Statistics database for England from April 2011 to March 2019 for all adult admissions for elective infrarenal AAA surgery. Data were extracted for the NHS trust and surgeon undertaking the procedure, the surgical technique used (open or endovascular), the financial year of admission, length of hospital and critical care stay during the procedure and subsequent emergency re-admissions (primary outcome) and deaths within 30 days. Multilevel modelling was used to adjust for hierarchy and confounding. RESULTS A dataset of 31 829 procedures (8867 open, 22 962 endovascular) was extracted. For open surgery, lower trust annual volume was associated with higher 30 day emergency re-admission rates and higher 30 day mortality. For open surgery, lower surgeon annual volume was associated with higher 30 day mortality and length of hospital stay greater than the median. For endovascular surgery, lower surgeon annual volume was associated with not having an overnight stay in critical care. None of the other volume-outcome relationships investigated was significant. CONCLUSION For elective infrarenal AAA surgery in the UK NHS, there was strong evidence of a volume-outcome relationship for open surgery. However, evidence for a volume-outcome relationship is dependent on the specific procedure undertaken and the outcome of interest.
Collapse
Affiliation(s)
- William K Gray
- Getting It Right First Time Programme, NHS England and NHS Improvement, London, UK
| | - Jamie Day
- Getting It Right First Time Programme, NHS England and NHS Improvement, London, UK
| | - Michael Horrocks
- Getting It Right First Time Programme, NHS England and NHS Improvement, London, UK.
| |
Collapse
|
20
|
Sawang M, Paravastu SCV, Liu Z, Thomas SD, Beiles CB, Mwipatayi BP, Verhagen HJM, Verhoeven ELG, Varcoe RL. The Relationship Between Operative Volume and Peri-operative Mortality After Non-elective Aortic Aneurysm Repair in Australia. Eur J Vasc Endovasc Surg 2020; 60:519-530. [PMID: 32624387 DOI: 10.1016/j.ejvs.2020.04.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 03/18/2020] [Accepted: 04/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Hospital and surgeon operative caseload is thought to be associated with peri-operative mortality following the non-elective repair of aortic aneurysms; however, whether such an association exists within the Australian healthcare setting is unknown. METHODS The Australasian Vascular Audit was interrogated to identify patients undergoing non-elective (emergency [EMG] or semi-urgent [URG]) aortic aneurysm repair between 2010 and 2016, as well as their treating surgeon and hospital. Hierarchal logistic regression modelling was used to assess the impact of caseload on outcomes after both endovascular (EVAR) and open surgical repair (OSR). RESULTS Volume counts were determined from 14 262 patients (4 121 OSR and 10 141 EVAR). After exclusion of elective procedures and duplicates, 1 153 EVAR (570 EMG and 583 URG) and 1 245 OSR (946 EMG and 299 URG) non-elective cases remained for the analysis. Crude mortality was 24.0% following OSR (EMG 29.2%; URG 7.7%) and 7.5% following EVAR (EMG 12.6%; URG 2.4%). Univariable analysis demonstrated an association between OSR mortality and hospital volume (quintile [Q] 1: 25.3%, Q2: 27.8%, Q3: 23.9%, Q4: 27.0%, Q5: 16.2%; p = .030), but not surgeon (Q1: 25.2%, Q2: 27.4%, Q3: 26.0%, Q4: 21.4%, Q5: 19.5%, p = .32). Multivariable analysis confirmed this association (odds ratio (OR) [95% CI]; Q1 vs 5: 1.91 [1.13-3.21], Q2 vs. 5: 2.01[1.24-3.25], Q3 vs. 5: 1.41 [0.86-2.29], Q4 vs. 5: 1.92 [1.17-3.15]; p = .020). The difference was most pronounced in the EMG OSR group [Q1 - 3 vs. 4-5] (OR 1.63 [1.07-2.48]; p = .020). Mortality after EVAR was not associated with either hospital (Q1: 6.3%, Q2: 10%, Q3: 6.8%, Q4: 4.5%, Q5: 10%; p = .14) or surgeon volume (Q1: 9.3%, Q2: 5.7%, Q3: 8.1%, Q4: 7.0%, Q5: 7.3%; p = .67). CONCLUSION There is an inverse correlation between hospital volume and peri-operative mortality following EMG open repair of aortic aneurysm. These data support restructuring Australian pathways of care to direct suspected ruptured aneurysm to institutions that reach a minimum volume threshold.
Collapse
Affiliation(s)
- Michael Sawang
- Department of Surgery, Prince of Wales Hospital, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Sharath C V Paravastu
- Department of Surgery, Prince of Wales Hospital, Sydney, Australia; Department of Vascular Surgery, Gloucestershire Hospitals NHS Foundation Trust, UK
| | - Zhixin Liu
- Stats Central, Mark Wainwright Analytical Centre, University of New South Wales, Sydney, Australia
| | - Shannon D Thomas
- Department of Surgery, Prince of Wales Hospital, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia; The Vascular Institute, Prince of Wales Hospital, Sydney, Australia
| | - Charles B Beiles
- Australasian Vascular Audit, Australian and New Zealand Society for Vascular Surgery, Melbourne, Australia
| | - Bibombe P Mwipatayi
- University of Western Australia, School of Surgery and Royal Perth Hospital, Department of Vascular Surgery, Perth, Australia
| | | | - Eric L G Verhoeven
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Ramon L Varcoe
- Department of Surgery, Prince of Wales Hospital, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia; The Vascular Institute, Prince of Wales Hospital, Sydney, Australia.
| |
Collapse
|
21
|
Tripodi P, Mestres G, Riambau V. Impact of Centralisation on Abdominal Aortic Aneurysm Repair Outcomes: Early Experience in Catalonia. Eur J Vasc Endovasc Surg 2020; 60:531-538. [PMID: 32312668 DOI: 10.1016/j.ejvs.2020.03.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 02/06/2020] [Accepted: 03/09/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Several studies have revealed high volume centres have better outcomes in the treatment of abdominal aortic aneurysms (AAAs), thus supporting centralisation of this procedure into selected centres based on volume. To date however, the real benefit of centralisation of this pathology has not been well demonstrated. The aim of this study was to analyse the impact of centralisation in to high volume centres (defined as those performing more than 30 cases per year) on AAA treatment outcomes carried out in Catalonia (Spain). METHODS Data were collected from official national registries (HDMBD) for AAA treated by endovascular aneurysm repair (EVAR) or open repair (OR) over a nine year period. Two time periods were selected for comparison: before centralisation (2009-2014) and after complete centralisation (2015-2017). The primary objective was to determine short term mortality (in hospital and 30 day mortality) and length of stay (LOS) after intact AAA (iAAA) and ruptured AAA (rAAA) repair, before and after centralisation. Uni- and multivariable analyses were performed in order to identify independent outcomes predictors. RESULTS A total of 3 501 iAAAs, including 1 124 (32.1%) OR and 2377 (67.9%) EVAR, and 409 rAAAs, including 218 (53.3%) OR and 191 (46.7%) EVAR, were identified. After centralisation, there was a significant decrease in overall mortality in iAAA repair (4.7% vs. 2.0%, p < .001) and rAAA repair (53.1% vs. 41.9%, p = .028). Mortality reduction in iAAAs was significant for OR (8.7% vs. 3.6%, p = .005), but not for EVAR (2.2% vs. 1.5%, p = .25). Overall LOS decreased as well, mainly in iAAAs (9.49 ± 10.84 vs. 7.44 ± 12.23 days, p < .001), and in particular in elective EVAR (7.32 ± 7.73 vs. 6.00 ± 8.97 days, p < .001). Multivariable analysis was identified before the centralisation period as an independent predictor for both mortality (odds ratio 1.484, 95% CI 1.098-2.005, p = .010) and LOS (B coefficient 1.146, 95% CI 0.218-2.073, p = .016). CONCLUSION The implementation of a country based centralisation programme for AAA treatment led to a significant reduction in short term mortality, for both iAAA and rAAA, and mainly for elective OR. LOS also significantly decreased, mainly for elective EVAR. These results support the benefit of centralisation of AAA repair procedures.
Collapse
Affiliation(s)
- Paolo Tripodi
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain. https://twitter.com/PaoloTripodi8
| | - Gaspar Mestres
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Vicente Riambau
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | -
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| |
Collapse
|
22
|
Hughes GC. INVITED COMMENTARY. Ann Thorac Surg 2020; 110:38-39. [PMID: 32109453 DOI: 10.1016/j.athoracsur.2020.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 01/02/2020] [Indexed: 11/18/2022]
Affiliation(s)
- G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Box 3051, Durham, NC 27710.
| |
Collapse
|
23
|
Boyle JR. Is In Hospital Mortality Following EVAR Still a Valid Outcome Measure? Eur J Vasc Endovasc Surg 2019; 57:520. [DOI: 10.1016/j.ejvs.2018.10.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 10/15/2018] [Indexed: 11/25/2022]
|
24
|
Wee IJY, Yap HY, Tang TY, Chong TT. Importance of Surgeon Experience in the Relationship Between Abdominal Aortic Aneurysm Surgery Volume and Peri-operative Mortality. Eur J Vasc Endovasc Surg 2019; 57:745-746. [PMID: 30736998 DOI: 10.1016/j.ejvs.2018.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 12/11/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Ian J Y Wee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hao Y Yap
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Tjun Y Tang
- Department of Vascular Surgery, Singapore General Hospital, Singapore.
| | - Tze T Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| |
Collapse
|