This article is more than 5 years old. Information may no longer be current.
Frequency of AAA repair may be inversely related to frequency of AAA rupture
Compared with the United States, England had a lower rate of repair of abdominal aortic aneurysms and a higher rate of abdominal aortic aneurysm rupture and related death, according to an analysis published in The New England Journal of Medicine.
The researchers analyzed data between 2005 and 2012 to compare the countries in frequency of aneurysm repair (whether endovascular or surgical), the rate of aneurysm rupture and the rate of aneurysm-related death. They also compared mean aneurysm diameter just before a repair procedure from 2014 in England and from 2013 in the United States.
U.S. data were taken from the Nationwide Inpatient Sample, the National Surgical Quality Improvement Program and the CDC. English data were taken from the Hospital Episode Statistics database, the National Vascular Registry and the Office of National Statistics. All data were adjusted for age and sex.
During the study period, 29,300 patients in England and 278,921 patients in the United States had repair of an intact AAA, Alan Karthikesalingam, PhD, MRCS, of St. George’s University of London, and colleagues reported.
They found that compared with the United States, AAA repair was less common (OR = 0.49; 95% CI, 0.48-0.49) and aneurysm-related death was more common (OR = 3.6; 95% CI, 3.55-3.64) in England.
In addition, hospitalization for AAA rupture was more common in England than in the United States (OR = 2.23; 95% CI, 2.19-2.27) and mean aneurysm diameter just before repair was larger in England (63.7 mm vs. 58.3 mm; P < .001), according to the researchers.
Among patients who underwent AAA repair, in-hospital mortality was 2.6% in England vs. 1.8% in the United States (OR = 1.04; 95% CI, 0.96-1.12), the researchers wrote. For endovascular repair, the rate was 0.9% in England and 0.8% in the United States; for surgical repair, it was 4.1% in England and 4% in the United States.
“We found that endovascular repair was used less frequently in England than in the United States, and endovascular repairs were performed at lower aneurysm diameters (in both countries) than open repair,” Karthikesalingam and colleagues wrote.
Although age at time of repair was younger in the United States, “the age discrepancy was not large enough to explain the observed differences in the rates of aneurysm repair, aneurysm rupture and death,” they wrote. – by Erik Swain
Disclosure: Karthikesalingam reports no relevant financial disclosures. Three researchers report financial ties with Cordis, Endologix, Medtronic and W.L. Gore & Associates.