Key result
In New Zealand, AAA-related hospitalizations decreased from 43.7 to 15.4 per 100,000 (2001-2018), and 30-day mortality for intact AAA repair declined from 5.8% to 1.7% (2001-2021).
Why the study?
Although the burden of AAA has changed over the last 20 years, it remains a major cause of cardiovascular mortality; this study aimed to assess the disease burden by analysing AAA-related hospitalisations and deaths.
Observational (n=19,436)
Yes
Over the past two decades in New Zealand, the incidence of AAA hospitalizations has declined and 30-day mortality for planned intact AAA repairs has significantly improved, though mortality for ruptured AAA remains high and unchanged.
Supports favorable intact AAA outcomes in recent NZ data; extends observational trends on EVAR adoption while leaving generalizability open.
PURPOSE: The burden of abdominal aortic aneurysms (AAA) has changed in the last 20 years but is still considered to be a major cause of cardiovascular mortality. The introduction of endovascular aortic repair (EVAR) and improved peri-operative care has resulted in a steady improvement in both outcomes and long-term survival. The objective of this study was to identify the burden of AAA disease by analysing AAA-related hospitalisations and deaths. METHODOLOGY: All AAA-related hospitalisations in NZ from January 2001 to December 2021 were identified from the National Minimum Dataset, and mortality data were obtained from the NZ Mortality Collection dataset from January 2001 to December 2018. Data was analysed for patient characteristics including deprivation index, repair methods and 30-day outcomes. RESULTS: From 2001 to 2021, 14,436 patients with an intact AAA were identified with a mean age of 75.1 years (SD 9.7 years), and 4100 (28%) were females. From 2001 to 2018, there were 5000 ruptured AAA with a mean age of 77.8 (SD 9.4), and 1676 (33%) were females. The rate of hospitalisations related to AAA has decreased from 43.7 per 100,000 in 2001 to 15.4 per 100,000 in 2018. There was a higher proportion of rupture AAA in patients living in more deprived areas. The use of EVAR for intact AAA repair has increased from 18.1% in 2001 to 64.3% in 2021. The proportion of octogenarians undergoing intact AAA repair has increased from 16.2% in 2001 to 28.4% in 2021. The 30-day mortality for intact AAA repair has declined from 5.8% in 2001 to 1.7% in 2021; however, it has remained unchanged for ruptured AAA repair at 31.6% across the same period. CONCLUSIONS: This study highlights that the incidence of AAA has declined in the last two decades. The mortality has improved for patients who had a planned repair. Understanding the contemporary burden of AAA is paramount to improve access to health, reduce variation in outcomes and promote surgical quality improvement.
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Gormley et al. (2023) conducted an observational in Abdominal aortic aneurysms (n=19,436). Abdominal aortic aneurysm repair was evaluated on AAA-related hospitalisations and 30-day mortality. In New Zealand, AAA-related hospitalizations decreased from 43.7 to 15.4 per 100,000 (2001-2018), and 30-day mortality for intact AAA repair declined from 5.8% to 1.7% (2001-2021).
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