Key result
Tertiary center AAA repair matches national registry 30-day mortality across elective and urgent settings.
Why the study?
Solid registries are crucial to audit results and improve practices in AAA repair, motivating a benchmark of single-center results against a national registry.
Does abdominal aortic aneurysm repair at a tertiary center yield comparable 30-day mortality to nationwide registry data in patients undergoing open or endovascular repair?
Observational (n=2,000)
Yes
Does abdominal aortic aneurysm repair at a tertiary center yield comparable 30-day mortality to nationwide registry data in patients undergoing open or endovascular repair?
Auditing a national registry demonstrates that a tertiary center's EVAR rates and 30-day mortality for AAA repair align with national practices, with urgent setting and age being significant mortality predictors.
Introduction: Solid registries are crucial to audit results and improve practices on aortic aneurysm (AAA) repair. Accordingly, the Portuguese Society for Vascular Surgery (SPACV) has implemented a national registry since 2019. We aimed to benchmark our results in the registry to identify discrepancies and improve practice. Methods: We compared data from the SPACV registry from November 2019 to December 2024 on consecutive patients subjected to aortic surgery in our center (cohort A) and nationwide (cohort B). We analyzed demographics, preoperative comorbidities and AAA characteristics (extent, diameter, admission mode). The primary outcome was 30-day mortality. Secondary outcomes included postoperative stroke, cardiac events and renal failure. Results: 2000 consecutive patients underwent surgery in cohort B, of which 402 were treated in group A (20.1%). Mean age was similar in both cohorts (73.7±8.5 in A vs. 73.9±11.5 in B). Most patients were male (92.8% in A vs. 93.22% in B). 58.2% of aneurysms were infrarenal. Most procedures were elective (79.9% in A vs. 80.9% in B) and predominantly endovascular (75.1% in A vs. 72.95% in B). Preoperative diameter was 63.5±16 mm, significantly larger in urgent cases (74.7±21.81 vs. 60.7±12.8mm). 30-day mortality in cohort A was 8.59%, in line with cohort B and significantly higher in urgent cases (31.25% vs 2.85%). 30-day mortality in both cohorts were similar. Cohort A 30-day rates for stroke, myocardial infarction, and bowel ischemia were 1.52%, 4.80%, and 4.04%, respectively. In cohort A, 30-day mortality significantly correlated with age (per 10-unit increase OR 1.068), urgent setting (OR 1.24) and preoperative creatinine (per-10 unit increase OR 1.001). EVAR conferred a reduced mortality risk (OR 0.88). Conclusions: Auditing national registries promotes better AAA repair outcomes. Our center's EVAR rates and 30-day mortality align with current national and international practices. Real-world data helps identify mortality predictors and potential improvements for daily practice.
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Duarte et al. (2025) conducted an observational in Abdominal aortic aneurysm (n=2,000). Abdominal aortic aneurysm repair at a tertiary center vs. Abdominal aortic aneurysm repair nationwide was evaluated on 30-day mortality. Abdominal aortic aneurysm repair at a tertiary center resulted in an 8.59% 30-day mortality rate, which aligned with national registry outcomes across both elective and urgent settings.
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