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

Anna J Alberga; Eleonora G Karthaus; Janneke A Wilschut; Jorg L de Bruin; George P Akkersdijk; Robert H Geelkerken; Jaap F Hamming; Jan J Wever; Hence J M Verhagen; Dutch Society of Vascular Surgery; Steering Committee of the Dutch Surgical Aneurysm Audit, and the Dutch Institute for Clinical Auditing

doi:10.1016/j.ejvs.2021.08.019

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

Eur J Vasc Endovasc Surg. 2022 Feb;63(2):275-283. doi: 10.1016/j.ejvs.2021.08.019. Epub 2022 Jan 10.

Collaborators

P J van den Akker, G P Akkersdijk, W L Akkersdijk, M G van Andringa de Kempenaer, C H P Arts, A M Avontuur, O J Bakker, R Balm, W B Barendregt, J A Bekken, M H M Bender, B L W Bendermacher, M van den Berg, R J Beuk, J D Blankensteijn, A S Bode, M E Bodegom, K E A van der Bogt, A P M Boll, M H Booster, B L S Borger van der Burg, G J de Borst, W T G J Bos-van Rossum, J Bosma, J M J Botman, L H Bouwman, V Brehm, M T de Bruijn, J L de Bruin, P Brummel, J P van Brussel, S E Buijk, M G Buimer, H C J L Buscher, E Cancrinus, P H Castenmiller, G Cazander, P H W M Cuypers, J H C Daemen, I Dawson, J E Dierikx, M L Dijkstra, J Diks, M K Dinkelman, M Dirven, D E J G J Dolmans, L M C van Dortmont, J W Drouven, M M van der Eb, D Eefting, G J W M van Eijck, J W M Elshof, B H P Elsman, A van der Elst, M I A van Engeland, G S van Eps, M J Faber, W M de Fijter, B Fioole, W M Fritschy, P H P F K Jin, R H Geelkerken, W B van Gent, G J Glade, B Govaert, R P R Groenendijk, H G W de Groot, R F F van den Haak, E F A de Haan, G F Hajer, J F Hamming, E S van Hattum, C E V B Hazenberg, P P H A Hedeman Joosten, J N Helleman, L G van der Hem, J M Hendriks, J A van Herwaarden, J M M Heyligers, J W Hinnen, R J Hissink, G H Ho, P T den Hoed, M T C Hoedt, F van Hoek, R Hoencamp, W H Hoffmann, A W J Hoksbergen, E J F Hollander, L C Huisman, R G Hulsebos, K M B Huntjens, M M Idu, M J H M Jacobs, M F P van der Jagt, J R H Jansbeken, R J L Janssen, H H L Jiang, S C de Jong, T A Jongbloed-Winkel, V Jongkind, M R Kapma, B P J A Keller, A K Jahrome, J K Kievit, P L Klemm, P Klinkert Jr, N A Koedam, M J W Koelemaij, J L P Kolkert, G G Koning, O H J Koning, R Konings, A G Krasznai, R H J Kropman, R R Kruse, L van der Laan, M J van der Laan, J H H van Laanen, G W van Lammeren, D A A Lamprou, J H P Lardenoije, G J Lauret, B J M Leenders, D A Legemate, V J Leijdekkers, M S Lemson, M M A Lensvelt, M A Lijkwan, F T H P M van der Linden, P F Liqui Lung, M J A Loos, M C Loubert, K M van de Luijtgaarden, D E A K Mahmoud, C G Manshanden, E C J L Mattens, R Meerwaldt, B M E Mees, T P Menting, R Metz, J C A de Mol van Otterloo, M J Molegraaf, Y C A Montauban van Swijndregt, M J M Morak, R H W van de Mortel, W Mulder, S K Nagesser, C C L M Naves, J H Nederhoed, A M Nevenzel, A J de Nie, D H Nieuwenhuis, R C van Nieuwenhuizen, J Nieuwenhuizen, D Nio, A P A Oomen, B I Oranen, J Oskam, H W Palamba, A G Peppelenbosch, A S van Petersen, B J Petri, M E N Pierie, A J Ploeg, R A Pol, E D Ponfoort, P P C Poyck, A Prent, S Ten Raa, J T F J Raymakers, B L Reichmann, M M P J Reijnen, J A M de Ridder, A Rijbroek, M J E van Rijn, R A de Roo, E V Rouwet, B R Saleem, M R H M van Sambeek, M G Samyn, H P van 't Sant, J van Schaik, P M van Schaik, D M Scharn, M R M Scheltinga, A Schepers, P M Schlejen, F J V Schlösser, F P G Schol, V P W Scholtes, O Schouten, M A Schreve, G W H Schurink, C J J M Sikkink, A Te Slaa, H J Smeets, L Smeets, R R Smeets, A A E A de Smet, P C Smit, T M Smits, M G J Snoeijs, A O Sondakh, M J Speijers, T J van der Steenhoven, S M M van Sterkenburg, D A A Stigter, R A Stokmans, R P Strating, G N M Stultiëns, J E M Sybrandy, J A W Teijink, B J Telgenkamp, M J G Testroote, T Tha-In, R M The, W J Thijsse, I Thomassen, I F J Tielliu, R B M van Tongeren, R J Toorop, E Tournoij, M Truijers, K Türkcan, R P Tutein Nolthenius, C Ünlü, R H D Vaes, A C Vahl, E J Veen, H T C Veger, M G Veldman, H J M Verhagen, B A N Verhoeven, C F W Vermeulen, E G J Vermeulen, B P Vierhout, R J van der Vijver-Coppen, M J T Visser, J A van der Vliet, C J van Vlijmen-van Keulen, J R van der Vorst, A W F Vos, C G Vos, G A Vos, B de Vos, M T Voûte, B H R Vriens, P W H E Vriens, D K de Vries, J P P M de Vries, M de Vries, A C de Vries, C van der Waal, E J Waasdorp, B M Wallis de Vries, L A van Walraven, J L van Wanroi, M C Warlé, V van Weel, A M E van Well, G M J M Welten, J J Wever, A M Wiersema, O R M Wikkeling, W I M Willaert, J Wille, M C M Willems, E M Willigendael, E D Wilschut, W Wisselink, M E Witte, C H A Wittens, C Y Wong, O Yazar, K K Yeung, C J A M Zeebregts, M L P van Zeeland

Affiliations

¹ Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands; Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands. Electronic address: a.alberga@erasmusmc.nl.
² Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands.
³ Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
⁴ Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
⁵ Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands.
⁶ Department of Surgery, Hospital Medisch Spectrum Twente, Enschede, The Netherlands; Multi-Modality Medical Imaging group, TechMed Centre, University of Twente, Enschede, The Netherlands.
⁷ Department of Vascular Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
⁸ Department of Vascular Surgery, Haga Teaching Hospital, The Hague, The Netherlands.

PMID: 35027275
DOI: 10.1016/j.ejvs.2021.08.019

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Abdominal aortic aneurysm; Endovascular procedure; Operative procedure; Quality of care; Treatment outcome; Trends.

MeSH terms

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 Procedures / adverse effects
Endovascular Procedures / statistics & numerical data*
Female
Hospital Mortality / trends
Humans
Male
Middle Aged
Netherlands / epidemiology
Postoperative Complications / epidemiology*
Postoperative Complications / etiology
Prospective Studies
Registries / statistics & numerical data
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome