Short- and long-term survival after open versus endovascular repair of abdominal aortic aneurysm-Polish population analysis

• Published in: PloS one Vol. 13; no. 6; p. e0198966
• Main Authors: Symonides, Bartosz, Śliwczyński, Andrzej, Gałązka, Zbigniew, Pinkas, Jarosław, Gaciong, Zbigniew
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 14.06.2018; Public Library of Science (PLoS)
• Subjects: Abdomen; Abdominal aortic aneurysm; Age; Aged; Analysis; Aneurysms; Aorta; Aortic Aneurysm, Abdominal - surgery; Aortic aneurysms; Biology and Life Sciences; Cardiovascular system; Care and treatment; Clinical medicine; Coronary vessels; Endovascular Procedures - methods; Endovascular stents; Female; Hazards; Humans; Hypertension; Internal medicine; Male; Males; Medical records; Medicine and Health Sciences; Mortality; Mortality risk; Observational studies; Patients; People and Places; Poland; Population; Public health; Research and Analysis Methods; Retrospective Studies; Survival; Survival Analysis; Systematic review; Time Factors; Treatment outcome; Poland; England; Hungary; United Kingdom > UK; Australia; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0198966

The aim of the study was to compare short and long-term mortality and readmissions in patients with non-ruptured abdominal aortic aneurysm (AAA) treated with endovascular aortic repair (EVAR) or open aneurysm repair (OAR). Retrospective survival analysis based on prospectively collected medical records of the national Polish public health insurer. In the National Health Fund database we identified all patients who underwent elective open or endovascular treatment of AAA between January 1st 2011 and March 22nd 2016. The data on mortality, selected concomitant diseases and readmissions were collected. A total of 7805 patients (mean age 70.9±8.1 yrs, 85.8% males) underwent OAR (n = 2336) or EVAR (n = 5469). A median follow up was 27.5 months (IQR range 10.0-38.4 months). The primary outcome variable was all-cause mortality, secondary outcomes included 30-day mortality and readmissions. Kaplan-Meier (K-M), Cox proportional-hazards and propensity score analyses were performed for primary and secondary outcomes adjusting for repair type of AAA (OAR vs. EVAR), age, sex and concomitant diseases. EVAR patients had higher all-cause mortality (6.4% vs. 4.6% P = 0.002, adjHR 1.34, 95%CI 1.07-1.67, P = 0.010) compared with OAR. The mortality risks for OAR patients decreased below those for EVAR patients after 9.9 months. Of all the tested confounding factors only age independently and significantly influenced long-term mortality. Readmissions occurred more often in EVAR than in OAR (16.5% vs. 8.4% P<0.001, adjHR 2.15, 95%CI 1.84-2.52, P<0.001) independently from other covariants. Survival and readmissions Kaplan-Meier curves remained statistically different between OAR and EVAR patients after propensity score matching. Survival benefit of EVAR over OAR disappeared early during the first year after procedure, particularly in patients below 70 years of age, accompanied by an increased frequency of readmissions of EVAR patients. Our data suggest re-evaluation of the strategy for AAA management in vascular units in the country.