| Title: |
Long-term Mortality and Reintervention After Endovascular and Open Abdominal Aortic Aneurysm Repairs in Australia, Germany, and the United States |
| Authors: |
Mao, Jialin; Behrendt, Christian-Alexander; Falster, Michael O.; Varcoe, Ramon L.; Zheng, Xinyan; Peters, Frederik; Beiles, Barry; Schermerhorn, Marc L.; Jorm, Louisa; Beck, Adam W.; Sedrakyan, Art |
| Source: |
Annals of Surgery ; volume 278, issue 3, page e626-e633 ; ISSN 0003-4932 |
| Publisher Information: |
Ovid Technologies (Wolters Kluwer Health) |
| Publication Year: |
2022 |
| Description: |
Objective: To examine long-term outcomes after endovascular (EVAR) and open repairs (OAR) for intact abdominal aortic aneurysms in Australia, Germany, and the United States, using a unified study design. Background: Similarities and differences in long-term outcomes after EVAR versus OAR across countries remained unclear, given differences in designs across existing studies. Methods: We identified patients aged >65 years undergoing intact abdominal aortic aneurysm repairs during 2010-2017/2018. We compared long-term patient mortality and reintervention after EVAR and OAR using Kaplan-Meier analyses and Cox regressions. Propensity score matching was performed within each country to adjust for differences in baseline patient characteristics between procedure groups. Results: We included 3311, 4909, and 145363 patients from Australia, Germany, and the United States, respectively. The median patient age was 76 to 77 years, and most patients were males (77%–84%). Patient mortality was lower after EVAR than OAR within the first 60 days and became similar at 3-year follow-up (Australia 14.7% vs 16.5%, Germany 18.2% vs 19.7%, United States: 24.4% vs 24.4%). At the end of follow-up, patient mortality after EVAR was higher than OAR in Australia [ hazard ratio (HR) 95% CI: 1.21 (0.96-1.54)] but similar to OAR in Germany [HR 95% CI: 0.92 (0.80-1.07)] and the United States [HR 95% CI: 1.02 (0.99-1.05)]. The risk of reintervention after EVAR was more than twice that after OAR in Australia [HR 95% CI: 2.60 (1.09-6.15)], Germany [HR 95% CI: 4.79 (2.56-8.98)], and the United States [HR 95% CI: 2.67 (2.38-3.00)]. The difference in reintervention risk appeared early in German and United States patients. Conclusions: This multinational study demonstrated important similarities in long-term outcomes after EVAR versus OAR across 3 countries. Variation in long-term mortality and reintervention comparisons indicates possible differences in patient profiles, surveillance, and best medical therapy across countries. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1097/sla.0000000000005768 |
| DOI: |
10.1097/SLA.0000000000005768 |
| Availability: |
https://doi.org/10.1097/sla.0000000000005768; https://journals.lww.com/10.1097/SLA.0000000000005768 |
| Accession Number: |
edsbas.5BDFBDC |
| Database: |
BASE |