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Gorricho J, Leache L, Tamayo I, Sánchez-Sáez F, Almirantearena M, San Román E, Ballaz J, Turumbay J, Librero J. Data Resource Profile: Results Analysis Base of Navarre (BARDENA). Int J Epidemiol 2023; 52:e301-e307. [PMID: 37898988 PMCID: PMC10749752 DOI: 10.1093/ije/dyad144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/17/2023] [Indexed: 10/31/2023] Open
Affiliation(s)
- Javier Gorricho
- Servicio de Evaluación y Difusión de Resultados en Salud, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Leire Leache
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
- Sección de Innovación y Organización, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - Ibai Tamayo
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
- Unidad de Metodología-Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Pamplona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain
| | - Francisco Sánchez-Sáez
- School of Engineering and Technology, Universidad Internacional de La Rioja, Logroño, Spain
| | - Maite Almirantearena
- Servicio de Evaluación y Difusión de Resultados en Salud, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - Edurne San Román
- Servicio de Tecnologías de Salud, Dirección General de Telecomunicaciones y Digitalización, Pamplona, Spain
| | - Jerónimo Ballaz
- Servicio de Tecnologías de Salud, Dirección General de Telecomunicaciones y Digitalización, Pamplona, Spain
| | - Javier Turumbay
- Subdirección de Sistemas y Tecnologías para la Salud, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - Julián Librero
- Unidad de Metodología-Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Pamplona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain
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Tseng CN, Yu SY, Chang YT, Peng WS, Lin CY, See LC. Safety of the endovascular aneurysm repair procedure: real-world evidence using interrupted-time series analysis. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2022; 62:6649730. [PMID: 35876877 DOI: 10.1093/ejcts/ezac370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/25/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES In Taiwan, endovascular aneurysm repair for treating abdominal aortic aneurysms (AAA) was introduced in 2004 and became reimbursable in February 2010. We evaluated the real-world practice and safety of endovascular aneurysm repair in Taiwan. METHODS Patients who underwent repair operations for AAA (open or endovascular) from 2000 to 2016 were enrolled (n = 11485). Outcome statistics (during the index hospitalization: length of stay, rate of ischaemic bowel disease and 30-day mortality; after discharge: 30-day readmission rate, 2-year mortality, 2-year reintervention rate and 2-year paraplegia rate) were calculated for each half-year cohort. Propensity score-based stabilized weights were used to balance covariates among each half-year cohort. Interrupted time-series analysis was then performed. RESULTS The elective and emergency ratio of AAA repair was 50:50 from 2000 to 2004 and became 60:40 from 2010 to 2016. The half-year rate of endovascular aneurysm repair was 0% in 2000 to 2004/06, 83.16% in 2010 and 98.1% in 2016. Interrupted time series analysis revealed that after endovascular aneurysm repair became reimbursable, both elective and emergency groups had a reduction in length of stay (-4.2 days, P < 0.0001; -1.5 days, P = 0.0928) and 30-day mortality (-5.22%, P = 0.0702; -7.76%, P = 0.0086) but a significant increase in the reintervention rate (5.05%, P = 0.0031; 4.36%, P = 0.0097). CONCLUSIONS Endovascular aneurysm repair was predominantly used in treating AAAs after it was reimbursed in Taiwan. Endovascular aneurysm repair is efficacious regarding short-term outcomes but increased the 2-year reintervention rate in both groups.
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Affiliation(s)
- Chi-Nan Tseng
- Division of Cardiac Surgery, Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Sheng-Yueh Yu
- Division of Vascular Surgery, Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Ya-Ting Chang
- Department of Pediatrics, Chang Gung Children's Hospital at Linkou, Taoyuan City, Taiwan
| | - Wei-Sheng Peng
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chun-Yu Lin
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Tucheng Branch, New Taipei City, Taiwan
| | - Lai-Chu See
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan City, Taiwan.,Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
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Bonfill X, Quintana MJ, Escudero JR, Miralles M, Fité J, Mikelarena E, Castejón B, Garnica M, Fernández DE Valderrama I, Rodriguez-Montalban A, Pijoan JI, Bellmunt-Montoya S. Appropriateness of surgery performed for abdominal aortic aneurysm at tertiary hospitals in Spain. INT ANGIOL 2021; 40:289-296. [PMID: 34060282 DOI: 10.23736/s0392-9590.21.04654-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To analyze the appropriateness of the type of repair (open or endovascular) performed for abdominal aortic aneurysm (AAA) in five university hospitals in Spain, according to evidence-based recommendations. METHODS A multicenter, retrospective cross-sectional study of patients with AAA who underwent elective open surgical repair (OSR) or endovascular aneurysm repair (EVAR). Data were collected on demographic and clinical variables and type of surgical repair. A pair of vascular surgeons from each participating hospital performed a blinded assessment based on GRADE recommendations. The concordance between the two evaluators and the agreement between their evidence-based recommendation and the procedure actually performed were assessed. RESULTS A total of 186 patients were selected; 179 were included. Mean age was 72.5 years (standard deviation [SD], 8.4), mean Charlson Comorbidity Index (CCI) was 2.04 (SD, 1.9). OSR was performed in 53.2% (n=99) and EVAR in 46.8% (n=87) of cases. Overall, 65.9% (118/179) of interventions performed were considered appropriate: 50% (47/94) of OSRs and 83.5% (71/85) of EVARs. The patient characteristics were similar for all the hospitals, but the chosen surgical technique did show significant differences among these centers. There were no significant differences among the hospitals in the proportion of cases judged as appropriate, either overall (p=0.346) or for each type of procedure (p=0.531 and p=0.538 for OSR and EVAR, respectively). CONCLUSIONS In this study, the majority of the AAA repairs performed were appropriate according to GRADE recommendations. A higher proportion of EVARs were considered appropriate than OSRs. Choice of AAA repair should be standardized through the use of evidence-based clinical practice guidelines, while incorporating patient preferences, to reduce the existing variability and ensure appropriate selection of AAA repair technique.
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Affiliation(s)
- Xavier Bonfill
- Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Spain - .,CIBER for Epidemiology and Public Health (CIBERESP), Madrid, Spain - .,Autonomous University of Barcelona, Barcelona, Spain -
| | - M Jesús Quintana
- Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Spain.,CIBER for Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Autonomous University of Barcelona, Barcelona, Spain
| | - Jose R Escudero
- Autonomous University of Barcelona, Barcelona, Spain.,Joint Service of Angiology, Vascular and Endovascular Surgery, University Hospital de la Santa Creu i Sant Pau-Hospital Dos de Maig, Barcelona, Spain.,CIBER for Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Manuel Miralles
- Department of Surgery, University of Valencia, Valencia, Spain
| | - Joan Fité
- Joint Service of Angiology, Vascular and Endovascular Surgery, University Hospital de la Santa Creu i Sant Pau-Hospital Dos de Maig, Barcelona, Spain
| | | | | | | | | | | | - José I Pijoan
- CIBER for Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Clinical Epidemiology Unit, Cruces University Hospital. Biocruces-Bizkaia Health Research Institute, Barakaldo, Spain
| | - Sergi Bellmunt-Montoya
- Autonomous University of Barcelona, Barcelona, Spain.,CIBER for Cardiovascular Diseases (CIBERCV), Madrid, Spain.,Department of Angiology, Vascular and Endovascular Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.,Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
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Trenner M, Salvermoser M, Reutersberg B, Busch A, Schmid V, Eckstein HH, Kuehnl A. Regional variation in endovascular treatment rate and in-hospital mortality of abdominal aortic aneurysms in Germany. VASA 2020; 49:107-114. [DOI: 10.1024/0301-1526/a000830] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Summary: Background: Abdominal aortic aneurysms (AAA) can be treated by either open surgery (OAR) or endovascular aortic repair (EVAR). The aim of this study was to analyze regional variations in application of (EVAR) and in-hospital mortality after intact AAA (iAAA) repair. Methods: Using data provided by the German Federal Statistical Office, a nationwide analysis for 2012 to 2014 was conducted. Patients with a diagnosis of iAAA (I71.4) and corresponding procedure codes for OAR (5-384.5/7) or EVAR (5-38a.1) were included. Odds ratios (ORs) for use of EVAR (proportion of EVAR among total EVAR + OAR cases) and mortality were calculated for all regions in Germany. ORs for EVAR use were adjusted for age, sex, and risk (Elixhauser score). ORs for mortality were additionally adjusted for type of procedure (OAR/EVAR). Results: Finally, 31,757 procedures for iAAA were included. Median age of all patients was 73 years (interquartile range 67–78 years) and 87.1 % were male. The mean proportion of EVAR procedures was 72.6 %; however, the application of EVAR for repair of iAAA varied widely depending on region. The lowest unadjusted regional rate of EVAR use was 48.8 %, while the highest was 92.5 %. After adjustment, the lowest regional OR for EVAR use (compared to the nationwide mean) was 0.23 (95 % confidence interval [0.15–0.36]), the highest 5.93 [1.79–19.65]. Overall in-hospital mortality was 2.9 % (OAR 6.2 %; EVAR 1.7 %). The adjusted regional OR for mortality ranged from 0.31 [0.07–1.42] to 4.98 [2.08–11.93]. Conclusions: This study reveals variations in use of EVAR and in-hospital mortality for iAAA treatment in Germany. This may imply that selection of treatment might not only be influenced by patient characteristics, but also by regional location. These results need to be taken into account when discussing centralization of AAA treatment in Germany.
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Affiliation(s)
- Matthias Trenner
- Department for Vascular and Endovascular Surgery, Munich Aortic Centre (MAC), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Salvermoser
- Department for Vascular and Endovascular Surgery, Munich Aortic Centre (MAC), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Benedikt Reutersberg
- Department for Vascular and Endovascular Surgery, Munich Aortic Centre (MAC), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Albert Busch
- Department for Vascular and Endovascular Surgery, Munich Aortic Centre (MAC), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Volker Schmid
- Department of Statistics, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Munich Aortic Centre (MAC), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andreas Kuehnl
- Department for Vascular and Endovascular Surgery, Munich Aortic Centre (MAC), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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