Regional Differences in Case Mix and Peri-operative Outcome After Elective Abdominal Aortic Aneurysm Repair in the Vascunet Database

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Mani, KevinUppsala universitet,Kärlkirurgi (author)

Regional Differences in Case Mix and Peri-operative Outcome After Elective Abdominal Aortic Aneurysm Repair in the Vascunet Database

Article/chapterEnglish2015

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Elsevier BV,2015
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LIBRIS-ID:oai:DiVA.org:uu-258349
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-258349URI
https://doi.org/10.1016/j.ejvs.2015.01.021DOI

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Language:English
Summary in:English

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Objective/background: National differences exist in the outcome of elective abdominal aortic aneurysm (AAA) repair. The role of case mix variation was assessed based on an international vascular registry collaboration. Methods: All elective AAA repairs with aneurysm size data in the Vascunet database in the period 2005-09 were included. AAA size and pen-operative outcome (crude and age adjusted mortality) were analysed overall and in risk cohorts, as well as per country. Glasgow Aneurysm Score (GAS) was calculated as risk score, and patients were stratified in three equal sized risk cohorts based on GAS. Predictors of pen-operative mortality were analysed with multiple regression. Missing data were handled with multiple imputation. Results: Patients from Australia, Finland, Hungary, Norway, Sweden and the UK (n = 5,895) were analysed; mean age was 72.7 years and 54% had endovascular repair (EVAR). There were significant variations in GAS (lowest = Finland [75.7], highest = UK [79.4], p for comparison of all regions < .001), proportion of AAA < 5.5 cm (lowest = UK [6.4%], highest = Hungary [29.0%]; p < .001), proportion undergoing EVAR (lowest = Finland [10.1%], highest = Australia [58.9%]; p < .001), crude mortality (lowest = Norway [2.0%], highest = Finland [5.0%]; p = .006), and age adjusted mortality (lowest = Norway [2.5%], highest = Finland [6.0%]; p = .048). Both aneurysm size and pen-operative mortality were highest among patients with a GAS >82. Of those with a GAS >82, 8.4% of men and 20.8% of women had an AAA <5.5 cm. Conclusion: Important regional differences exist in case selection for elective AAA repair, including variations in AAA size and patient risk profile. These differences partly explain the variations in pen-operative mortality. Further audit is warranted to assess the underlying reasons for the regional variation in case-mix.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kirurgi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Surgery hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kardiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Cardiac and Cardiovascular Systems hsv//eng
Abdominal aortic aneurysm
Case mix
Outcome
Regional differences

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Venermo, M. (author)
Beiles, B. (author)
Menyhei, G. (author)
Altreuther, M. (author)
Loftus, I. (author)
Björck, MartinUppsala universitet,Kärlkirurgi(Swepub:uu)mabjo425 (author)
Uppsala universitetKärlkirurgi (creator_code:org_t)

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In:European Journal of Vascular and Endovascular Surgery: Elsevier BV49:6, s. 646-6521078-58841532-2165

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By the author/editor: Mani, Kevin; Venermo, M.; Beiles, B.; Menyhei, G.; Altreuther, M.; Loftus, I.; show more...; Björck, Martin; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Surgery

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