Long-term survival after endovascular and open repair of unruptured abdominal aortic aneurysm. Issue 13 (20th November 2019)

• Record Type: Journal Article
• Authors: Johal, A S; Loftus, I M; Boyle, J R; Heikkila, K; Waton, S; Cromwell, D A
• Is Part Of: British journal of surgery. Volume 106:Issue 13(2019)
• Page Start: 1784
• Page End: 1793
• Publication Date: 2019-11-20
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs.11215
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Background: The aim of this study was to examine patterns of 10-year survival after elective repair of unruptured abdominal aortic aneurysms (AAAs) in different patient groups. Methods: Patients having open repair or endovascular aneurysm repair (EVAR) in the English National Health Service between January 2006 and December 2015 were identified from Hospital Episode Statistics data. Postoperative survival among patients of different age and Royal College of Surgeons of England (RCS) modified Charlson co-morbidity score profiles were analysed using flexible parametric survival models. The relationship between patient characteristics and risk of rupture after repair was also analysed. Results: Some 37 138 patients underwent elective AAA repair, of which 15 523 were open and 21 615 were endovascular. The 10-year mortality rate was 38·1 per cent for patients aged under 70 years, and the survival trajectories for open repair and EVAR were similar when patients had no RCS-modified Charlson co-morbidity. Among older patients or those with co-morbidity, the 10-year mortality rate rose, exceeding 70 per cent for patients aged 80 years. Mean survival times over 10 years for open repair and EVAR were often similar in subgroups of older and more co-morbid patients, but their survival trajectories became increasingly dissimilar, with open repair showing greater short-term risk within 6 months but lower 10-year mortality rates. The risk of rupture over 9 years was 3·4 per cent for EVAR and 0·9 per cent for open repair, and was weakly associated with patient factors. Conclusion: Long-term survival patterns after elective open repair and EVAR for unruptured AAA vary markedly across patients with different age and co-morbidity profiles. Graphical Abstract: This paper describes the long-term survival patterns of patients following endovascular and open repair of unruptured abdominal aortic aneurysms. Patients were stratified by age group and co-morbidity, and a regression method that overcomes the violation of the Cox proportional hazards assumption was used. Long-term survival varied markedly by patient group. K–M, Kaplan–Meier; EVAR, endovascular aneurysm repair. Marked variation with age and comorbidity