Key result
EVAR linked to ~73% lower in-hospital mortality versus open surgery for intact AAA.
Why the study?
Regional variations in the use of endovascular aortic repair and in-hospital mortality after intact abdominal aortic aneurysm repair in Germany were not well characterized.
Does regional location influence the rate of EVAR use and in-hospital mortality in patients undergoing repair of intact abdominal aortic aneurysms?
Observational (n=31,757)
Yes
Does regional location influence the rate of EVAR use and in-hospital mortality in patients undergoing repair of intact abdominal aortic aneurysms?
Absolute Event Rate: 1.7% vs 6.2%
There is significant regional variation in the utilization of EVAR and in-hospital mortality for intact AAA repair in Germany, suggesting treatment selection is influenced by location.
Regional variation in EVAR use and mortality for intact AAA warrants caution applying aggregate results; leaves open the role of local factors in treatment selection.
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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Trenner et al. (2019) conducted an observational in Intact abdominal aortic aneurysms (n=31,757). Endovascular aortic repair (EVAR) vs. Open surgery (OAR) was evaluated on In-hospital mortality. Endovascular aortic repair for intact abdominal aortic aneurysms had an in-hospital mortality of 1.7% versus 6.2% for open surgery, though treatment selection and mortality varied widely by region.
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