Treatment Outcome Trends for Non-Ruptured Abdominal Aortic Aneurysms: A Nationwide Prospective Cohort Study

• Published in: European journal of vascular and endovascular surgery Vol. 63; no. 2; pp. 275 - 283
• Main Authors: Karthaus, Eleonora G., de Bruin, Jorg L., Akkersdijk, George P., Wever, Jan J., van den Akker, P.J., Akkersdijk, W.L., van Andringa de Kempenaer, M.G., Barendregt, W.B., Bekken, J.A., Bender, M.H.M., Bendermacher, B.L.W., Blankensteijn, J.D., Bodegom, M.E., Borger van der Burg, B.L.S., de Borst, G.J., Botman, J.M.J., Bouwman, L.H., Brehm, V., Buijk, S.E., Buimer, M.G., Buscher, H.C.J.L., Daemen, J.H.C., Dawson, I., Eefting, D., van der Elst, A., van Engeland, M.I.A., Faber, M.J., Glade, G.J., Groenendijk, R.P.R., de Haan, E.F.A., Hajer, G.F., van Hattum, E.S., van der Hem, L.G., van Herwaarden, J.A., Heyligers, J.M.M., Hinnen, J.W., Hoencamp, R., Hoksbergen, A.W.J., Hollander, E.J.F., Jacobs, M.J.H.M., van der Jagt, M.F.P., Jiang, H.H.L., Jahrome, A.K., Kievit, J.K., Klemm, P.L., Kolkert, J.L.P., Kropman, R.H.J., van der Laan, L., van Lammeren, G.W., Lauret, G.J., Legemate, D.A., Lensvelt, M.M.A., van der Linden, F.T.h.P.M., Loubert, M.C., Mahmoud, D.E.A.K., Mattens, E.C.J.L., de Mol van Otterloo, J.C.A., Molegraaf, M.J., Montauban van Swijndregt, Y.C.A., van de Mortel, R.H.W., Naves, C.C.L.M., Nederhoed, J.H., de Nie, A.J., Petri, B.J., Pol, R.A., Poyck, P.P.C., Prent, A., Raa, S. ten, Rijbroek, A., de Roo, R.A., van Sambeek, M.R.H.M., Samyn, M.G., Schlejen, P.M., Scholtes, V.P.W., Smeets, H.J., Smit, P.C., Smits, T.M., Speijers, M.J., Stigter, D.A.A., Stultiëns, G.N.M., Telgenkamp, B.J., Thijsse, W.J., Toorop, R.J., Truijers, M., Türkcan, K., Tutein Nolthenius, R.P., Veen, E.J., van der Vijver-Coppen, R.J., Vos, C.G., de Vos, B., de Vries, M., Wallis de Vries, B.M., Warlé, M.C., Welten, G.M.J.M., Wever, J.J., Wikkeling, O.R.M., Willems, M.C.M., Witte, M.E., Wong, C.Y., Yazar, O.
• Format: Journal Article
• Language: English
• Published: England Elsevier B.V 01.02.2022
• Subjects: Abdominal aortic aneurysm; Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - surgery; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - statistics & numerical data; Endovascular procedure; Endovascular Procedures - adverse effects; Endovascular Procedures - statistics & numerical data; Female; Hospital Mortality - trends; Humans; Male; Middle Aged; Netherlands - epidemiology; Operative procedure; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prospective Studies; Quality of care; Registries - statistics & numerical data; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Trends; Netherlands; Endovascular procedure; Treatment outcome; Trends; Operative procedure; Quality of care; Abdominal aortic aneurysm
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2021.08.019

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. 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. 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. 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.