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For: Lijftogt N, Karthaus EG, Vahl A, van Zwet EW, van der Willik EM, Tollenaar RA, Hamming JF, Wouters MW, Van den Akker L, Van den Akker P, Akkersdijk G, Akkersdijk G, Akkersdijk W, van Andringa de Kempenaer M, Arts C, Avontuur J, Baal J, Bakker O, Balm R, Barendregt W, Bender M, Bendermacher B, van den Berg M, Berger P, Beuk R, Blankensteijn J, Bleker R, Bockel J, Bodegom M, Bogt K, Boll A, Booster M, Borger van der Burg B, de Borst G, Bos-van Rossum W, Bosma J, Botman J, Bouwman L, Breek J, Brehm V, Brinckman M, van den Broek T, Brom H, de Bruijn M, de Bruin J, Brummel P, van Brussel J, Buijk S, Buimer M, Burger D, Buscher H, den Butter G, Cancrinus E, Castenmiller P, Cazander G, Coveliers H, Cuypers P, Daemen J, Dawson I, Derom A, Dijkema A, Diks J, Dinkelman M, Dirven M, Dolmans D, van Doorn R, van Dortmont L, van der Eb M, Eefting D, van Eijck G, Elshof J, Elsman B, van der Elst A, van Engeland M, van Eps R, Faber M, de Fijter W, Fioole B, Fritschy W, Geelkerken R, van Gent W, Glade G, Govaert B, Groenendijk R, de Groot H, van den Haak R, de Haan E, Hajer G, Hamming J, van Hattum E, Hazenberg C, Hedeman Joosten P, Helleman J, van der Hem L, Hendriks J, van Herwaarden J, Heyligers J, Hinnen J, Hissink R, Ho G, den Hoed P, Hoedt M, van Hoek F, Hoencamp R, Hoffmann W, Hoksbergen A, Hollander E, Huisman L, Hulsebos R, Huntjens K, Idu M, Jacobs M, van der Jagt M, Jansbeken J, Janssen R, Jiang H, de Jong S, Jongkind V, Kapma M, Keller B, Khodadade Jahrome A, Kievit J, Klemm P, Klinkert P, Knippenberg B, Koedam N, Koelemaij M, Kolkert J, Koning G, Koning O, Krasznai A, Krol R, Kropman R, Kruse R, van der Laan L, van der Laan M, van Laanen J, Lardenoye J, Lawson J, Legemate D, Leijdekkers V, Lemson M, Lensvelt M, Lijkwan M, Lind R, van der Linden F, Liqui Lung P, Loos M, Loubert M, Mahmoud D, Manshanden C, Mattens E, Meerwaldt R, Mees B, Metz R, Minnee R, de Mol van Otterloo J, Moll F, Montauban van Swijndregt Y, Morak M, van de Mortel R, Mulder W, Nagesser S, Naves C, Nederhoed J, Nevenzel-Putters A, de Nie A, Nieuwenhuis D, Nieuwenhuizen J, van Nieuwenhuizen R, Nio D, Oomen A, Oranen B, Oskam J, Palamba H, Peppelenbosch A, van Petersen A, Peterson T, Petri B, Pierie M, Ploeg A, Pol R, Ponfoort E, Poyck P, Prent A, ten Raa S, Raymakers J, Reichart M, Reichmann B, Reijnen M, Rijbroek A, van Rijn M, de Roo R, Rouwet E, Rupert C, Saleem B, van Sambeek M, Samyn M, van ’t Sant H, van Schaik J, van Schaik P, Scharn D, Scheltinga M, Schepers A, Schlejen P, Schlosser F, Schol F, Schouten O, Schreinemacher M, Schreve M, Schurink G, Sikkink C, Siroen M, te Slaa A, Smeets H, Smeets L, de Smet A, de Smit P, Smit P, Smits T, Snoeijs M, Sondakh A, van der Steenhoven T, van Sterkenburg S, Stigter D, Stigter H, Strating R, Stultiëns G, Sybrandy J, Teijink J, Telgenkamp B, Testroote M, The R, Thijsse W, Tielliu I, van Tongeren R, Toorop R, Tordoir J, Tournoij E, Truijers M, Türkcan K, Tutein Nolthenius R, Ünlü Ç, Vafi A, Vahl A, Veen E, Veger H, Veldman M, Verhagen H, Verhoeven B, Vermeulen C, Vermeulen E, Vierhout B, Visser M, van der Vliet J, Vlijmen-van Keulen C, Voesten H, Voorhoeve R, Vos A, de Vos B, Vos G, Vriens B, Vriens P, de Vries A, de Vries J, de Vries M, van der Waal C, Waasdorp E, Wallis de Vries B, van Walraven L, van Wanroij J, Warlé M, van Weel V, van Well A, Welten G, Welten R, Wever J, Wiersema A, Wikkeling O, Willaert W, Wille J, Willems M, Willigendael E, Wisselink W, Witte M, Wittens C, Wolf-de Jonge I, Yazar O, Zeebregts C, van Zeeland M, Van den Akker L, Van den Akker P, Akkersdijk G, Akkersdijk G, Akkersdijk W, van Andringa de Kempenaer M, Arts C, Avontuur J, Baal J, Bakker O, Balm R, Barendregt W, Bender M, Bendermacher B, van den Berg M, Berger P, Beuk R, Blankensteijn J, Bleker R, Bockel J, Bodegom M, Bogt K, Boll A, Booster M, Borger van der Burg B, de Borst G, Bos-van Rossum W, Bosma J, Botman J, Bouwman L, Breek J, Brehm V, Brinckman M, van den Broek T, Brom H, de Bruijn M, de Bruin J, Brummel P, van Brussel J, Buijk S, Buimer M, Burger D, Buscher H, den Butter G, Cancrinus E, Castenmiller P, Cazander G, Coveliers H, Cuypers P, Daemen J, Dawson I, Derom A, Dijkema A, Diks J, Dinkelman M, Dirven M, Dolmans D, van Doorn R, van Dortmont L, van der Eb M, Eefting D, van Eijck G, Elshof J, Elsman B, van der Elst A, van Engeland M, van Eps R, Faber M, de Fijter W, Fioole B, Fritschy W, Geelkerken R, van Gent W, Glade G, Govaert B, Groenendijk R, de Groot H, van den Haak R, de Haan E, Hajer G, Hamming J, van Hattum E, Hazenberg C, Hedeman Joosten P, Helleman J, van der Hem L, Hendriks J, van Herwaarden J, Heyligers J, Hinnen J, Hissink R, Ho G, den Hoed P, Hoedt M, van Hoek F, Hoencamp R, Hoffmann W, Hoksbergen A, Hollander E, Huisman L, Hulsebos R, Huntjens K, Idu M, Jacobs M, van der Jagt M, Jansbeken J, Janssen R, Jiang H, de Jong S, Jongkind V, Kapma M, Keller B, Khodadade Jahrome A, Kievit J, Klemm P, Klinkert P, Knippenberg B, Koedam N, Koelemaij M, Kolkert J, Koning G, Koning O, Krasznai A, Krol R, Kropman R, Kruse R, van der Laan L, van der Laan M, van Laanen J, Lardenoye J, Lawson J, Legemate D, Leijdekkers V, Lemson M, Lensvelt M, Lijkwan M, Lind R, van der Linden F, Liqui Lung P, Loos M, Loubert M, Mahmoud D, Manshanden C, Mattens E, Meerwaldt R, Mees B, Metz R, Minnee R, de Mol van Otterloo J, Moll F, Montauban van Swijndregt Y, Morak M, van de Mortel R, Mulder W, Nagesser S, Naves C, Nederhoed J, Nevenzel-Putters A, de Nie A, Nieuwenhuis D, Nieuwenhuizen J, van Nieuwenhuizen R, Nio D, Oomen A, Oranen B, Oskam J, Palamba H, Peppelenbosch A, van Petersen A, Peterson T, Petri B, Pierie M, Ploeg A, Pol R, Ponfoort E, Poyck P, Prent A, ten Raa S, Raymakers J, Reichart M, Reichmann B, Reijnen M, Rijbroek A, van Rijn M, de Roo R, Rouwet E, Rupert C, Saleem B, van Sambeek M, Samyn M, van ’t Sant H, van Schaik J, van Schaik P, Scharn D, Scheltinga M, Schepers A, Schlejen P, Schlosser F, Schol F, Schouten O, Schreinemacher M, Schreve M, Schurink G, Sikkink C, Siroen M, te Slaa A, Smeets H, Smeets L, de Smet A, de Smit P, Smit P, Smits T, Snoeijs M, Sondakh A, van der Steenhoven T, van Sterkenburg S, Stigter D, Stigter H, Strating R, Stultiëns G, Sybrandy J, Teijink J, Telgenkamp B, Testroote M, The R, Thijsse W, Tielliu I, van Tongeren R, Toorop R, Tordoir J, Tournoij E, Truijers M, Türkcan K, Tutein Nolthenius R, Ünlü Ç, Vafi A, Vahl A, Veen E, Veger H, Veldman M, Verhagen H, Verhoeven B, Vermeulen C, Vermeulen E, Vierhout B, Visser M, van der Vliet J, Vlijmen-van Keulen C, Voesten H, Voorhoeve R, Vos A, de Vos B, Vos G, Vriens B, Vriens P, de Vries A, de Vries J, de Vries M, van der Waal C, Waasdorp E, Wallis de Vries B, van Walraven L, van Wanroij J, Warlé M, van Weel V, van Well A, Welten G, Welten R, Wever J, Wiersema A, Wikkeling O, Willaert W, Wille J, Willems M, Willigendael E, Wisselink W, Witte M, Wittens C, Wolf-de Jonge I, Yazar O, Zeebregts C, van Zeeland M. Failure to Rescue – a Closer Look at Mortality Rates Has No Added Value for Hospital Comparisons but Is Useful for Team Quality Assessment in Abdominal Aortic Aneurysm Surgery in The Netherlands. Eur J Vasc Endovasc Surg 2018;56:652-661. [DOI: 10.1016/j.ejvs.2018.06.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 06/24/2018] [Indexed: 01/14/2023]

For:	Lijftogt N, Karthaus EG, Vahl A, van Zwet EW, van der Willik EM, Tollenaar RA, Hamming JF, Wouters MW, Van den Akker L, Van den Akker P, Akkersdijk G, Akkersdijk G, Akkersdijk W, van Andringa de Kempenaer M, Arts C, Avontuur J, Baal J, Bakker O, Balm R, Barendregt W, Bender M, Bendermacher B, van den Berg M, Berger P, Beuk R, Blankensteijn J, Bleker R, Bockel J, Bodegom M, Bogt K, Boll A, Booster M, Borger van der Burg B, de Borst G, Bos-van Rossum W, Bosma J, Botman J, Bouwman L, Breek J, Brehm V, Brinckman M, van den Broek T, Brom H, de Bruijn M, de Bruin J, Brummel P, van Brussel J, Buijk S, Buimer M, Burger D, Buscher H, den Butter G, Cancrinus E, Castenmiller P, Cazander G, Coveliers H, Cuypers P, Daemen J, Dawson I, Derom A, Dijkema A, Diks J, Dinkelman M, Dirven M, Dolmans D, van Doorn R, van Dortmont L, van der Eb M, Eefting D, van Eijck G, Elshof J, Elsman B, van der Elst A, van Engeland M, van Eps R, Faber M, de Fijter W, Fioole B, Fritschy W, Geelkerken R, van Gent W, Glade G, Govaert B, Groenendijk R, de Groot H, van den Haak R, de Haan E, Hajer G, Hamming J, van Hattum E, Hazenberg C, Hedeman Joosten P, Helleman J, van der Hem L, Hendriks J, van Herwaarden J, Heyligers J, Hinnen J, Hissink R, Ho G, den Hoed P, Hoedt M, van Hoek F, Hoencamp R, Hoffmann W, Hoksbergen A, Hollander E, Huisman L, Hulsebos R, Huntjens K, Idu M, Jacobs M, van der Jagt M, Jansbeken J, Janssen R, Jiang H, de Jong S, Jongkind V, Kapma M, Keller B, Khodadade Jahrome A, Kievit J, Klemm P, Klinkert P, Knippenberg B, Koedam N, Koelemaij M, Kolkert J, Koning G, Koning O, Krasznai A, Krol R, Kropman R, Kruse R, van der Laan L, van der Laan M, van Laanen J, Lardenoye J, Lawson J, Legemate D, Leijdekkers V, Lemson M, Lensvelt M, Lijkwan M, Lind R, van der Linden F, Liqui Lung P, Loos M, Loubert M, Mahmoud D, Manshanden C, Mattens E, Meerwaldt R, Mees B, Metz R, Minnee R, de Mol van Otterloo J, Moll F, Montauban van Swijndregt Y, Morak M, van de Mortel R, Mulder W, Nagesser S, Naves C, Nederhoed J, Nevenzel-Putters A, de Nie A, Nieuwenhuis D, Nieuwenhuizen J, van Nieuwenhuizen R, Nio D, Oomen A, Oranen B, Oskam J, Palamba H, Peppelenbosch A, van Petersen A, Peterson T, Petri B, Pierie M, Ploeg A, Pol R, Ponfoort E, Poyck P, Prent A, ten Raa S, Raymakers J, Reichart M, Reichmann B, Reijnen M, Rijbroek A, van Rijn M, de Roo R, Rouwet E, Rupert C, Saleem B, van Sambeek M, Samyn M, van ’t Sant H, van Schaik J, van Schaik P, Scharn D, Scheltinga M, Schepers A, Schlejen P, Schlosser F, Schol F, Schouten O, Schreinemacher M, Schreve M, Schurink G, Sikkink C, Siroen M, te Slaa A, Smeets H, Smeets L, de Smet A, de Smit P, Smit P, Smits T, Snoeijs M, Sondakh A, van der Steenhoven T, van Sterkenburg S, Stigter D, Stigter H, Strating R, Stultiëns G, Sybrandy J, Teijink J, Telgenkamp B, Testroote M, The R, Thijsse W, Tielliu I, van Tongeren R, Toorop R, Tordoir J, Tournoij E, Truijers M, Türkcan K, Tutein Nolthenius R, Ünlü Ç, Vafi A, Vahl A, Veen E, Veger H, Veldman M, Verhagen H, Verhoeven B, Vermeulen C, Vermeulen E, Vierhout B, Visser M, van der Vliet J, Vlijmen-van Keulen C, Voesten H, Voorhoeve R, Vos A, de Vos B, Vos G, Vriens B, Vriens P, de Vries A, de Vries J, de Vries M, van der Waal C, Waasdorp E, Wallis de Vries B, van Walraven L, van Wanroij J, Warlé M, van Weel V, van Well A, Welten G, Welten R, Wever J, Wiersema A, Wikkeling O, Willaert W, Wille J, Willems M, Willigendael E, Wisselink W, Witte M, Wittens C, Wolf-de Jonge I, Yazar O, Zeebregts C, van Zeeland M, Van den Akker L, Van den Akker P, Akkersdijk G, Akkersdijk G, Akkersdijk W, van Andringa de Kempenaer M, Arts C, Avontuur J, Baal J, Bakker O, Balm R, Barendregt W, Bender M, Bendermacher B, van den Berg M, Berger P, Beuk R, Blankensteijn J, Bleker R, Bockel J, Bodegom M, Bogt K, Boll A, Booster M, Borger van der Burg B, de Borst G, Bos-van Rossum W, Bosma J, Botman J, Bouwman L, Breek J, Brehm V, Brinckman M, van den Broek T, Brom H, de Bruijn M, de Bruin J, Brummel P, van Brussel J, Buijk S, Buimer M, Burger D, Buscher H, den Butter G, Cancrinus E, Castenmiller P, Cazander G, Coveliers H, Cuypers P, Daemen J, Dawson I, Derom A, Dijkema A, Diks J, Dinkelman M, Dirven M, Dolmans D, van Doorn R, van Dortmont L, van der Eb M, Eefting D, van Eijck G, Elshof J, Elsman B, van der Elst A, van Engeland M, van Eps R, Faber M, de Fijter W, Fioole B, Fritschy W, Geelkerken R, van Gent W, Glade G, Govaert B, Groenendijk R, de Groot H, van den Haak R, de Haan E, Hajer G, Hamming J, van Hattum E, Hazenberg C, Hedeman Joosten P, Helleman J, van der Hem L, Hendriks J, van Herwaarden J, Heyligers J, Hinnen J, Hissink R, Ho G, den Hoed P, Hoedt M, van Hoek F, Hoencamp R, Hoffmann W, Hoksbergen A, Hollander E, Huisman L, Hulsebos R, Huntjens K, Idu M, Jacobs M, van der Jagt M, Jansbeken J, Janssen R, Jiang H, de Jong S, Jongkind V, Kapma M, Keller B, Khodadade Jahrome A, Kievit J, Klemm P, Klinkert P, Knippenberg B, Koedam N, Koelemaij M, Kolkert J, Koning G, Koning O, Krasznai A, Krol R, Kropman R, Kruse R, van der Laan L, van der Laan M, van Laanen J, Lardenoye J, Lawson J, Legemate D, Leijdekkers V, Lemson M, Lensvelt M, Lijkwan M, Lind R, van der Linden F, Liqui Lung P, Loos M, Loubert M, Mahmoud D, Manshanden C, Mattens E, Meerwaldt R, Mees B, Metz R, Minnee R, de Mol van Otterloo J, Moll F, Montauban van Swijndregt Y, Morak M, van de Mortel R, Mulder W, Nagesser S, Naves C, Nederhoed J, Nevenzel-Putters A, de Nie A, Nieuwenhuis D, Nieuwenhuizen J, van Nieuwenhuizen R, Nio D, Oomen A, Oranen B, Oskam J, Palamba H, Peppelenbosch A, van Petersen A, Peterson T, Petri B, Pierie M, Ploeg A, Pol R, Ponfoort E, Poyck P, Prent A, ten Raa S, Raymakers J, Reichart M, Reichmann B, Reijnen M, Rijbroek A, van Rijn M, de Roo R, Rouwet E, Rupert C, Saleem B, van Sambeek M, Samyn M, van ’t Sant H, van Schaik J, van Schaik P, Scharn D, Scheltinga M, Schepers A, Schlejen P, Schlosser F, Schol F, Schouten O, Schreinemacher M, Schreve M, Schurink G, Sikkink C, Siroen M, te Slaa A, Smeets H, Smeets L, de Smet A, de Smit P, Smit P, Smits T, Snoeijs M, Sondakh A, van der Steenhoven T, van Sterkenburg S, Stigter D, Stigter H, Strating R, Stultiëns G, Sybrandy J, Teijink J, Telgenkamp B, Testroote M, The R, Thijsse W, Tielliu I, van Tongeren R, Toorop R, Tordoir J, Tournoij E, Truijers M, Türkcan K, Tutein Nolthenius R, Ünlü Ç, Vafi A, Vahl A, Veen E, Veger H, Veldman M, Verhagen H, Verhoeven B, Vermeulen C, Vermeulen E, Vierhout B, Visser M, van der Vliet J, Vlijmen-van Keulen C, Voesten H, Voorhoeve R, Vos A, de Vos B, Vos G, Vriens B, Vriens P, de Vries A, de Vries J, de Vries M, van der Waal C, Waasdorp E, Wallis de Vries B, van Walraven L, van Wanroij J, Warlé M, van Weel V, van Well A, Welten G, Welten R, Wever J, Wiersema A, Wikkeling O, Willaert W, Wille J, Willems M, Willigendael E, Wisselink W, Witte M, Wittens C, Wolf-de Jonge I, Yazar O, Zeebregts C, van Zeeland M. Failure to Rescue – a Closer Look at Mortality Rates Has No Added Value for Hospital Comparisons but Is Useful for Team Quality Assessment in Abdominal Aortic Aneurysm Surgery in The Netherlands. Eur J Vasc Endovasc Surg 2018;56:652-661. [DOI: 10.1016/j.ejvs.2018.06.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 06/24/2018] [Indexed: 01/14/2023]

Number

Cited by Other Article(s)

Rafaqat W, Lagazzi E, Jehanzeb H, Abiad M, Luckhurst CM, Parks JJ, Albutt KH, Hwabejire JO, DeWane MP. Does practice make perfect? The impact of hospital and surgeon volume on complications after intra-abdominal procedures. Surgery 2024;175:1312-1320. [PMID: 38418297 DOI: 10.1016/j.surg.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/26/2023] [Accepted: 01/12/2024] [Indexed: 03/01/2024]

Abstract

BACKGROUND

There is increasing interest in the regionalization of surgical procedures. However, evidence on the volume-outcome relationship for emergency intra-abdominal surgery is not well-synthesized. This systematic review and meta-analysis summarize evidence regarding the impact of hospital and surgeon volume on complications.

METHODS

We identified cohort studies assessing the impact of hospital/surgeon volume on postoperative complications after emergency intra-abdominal procedures, with data collected after the year 2000 through a literature search without language restriction in the PubMed, Web of Science, and Cochrane databases. A weighted overall complication rate was calculated, and a random effect regression model was used for a summary odds ratio. A sensitivity analysis with the removal of studies contributing to heterogeneity was performed (PROSPERO: CRD42022358879).

RESULTS

The search yielded 2,153 articles, of which 9 cohort studies were included and determined to be good quality according to the Newcastle Ottawa Scale. These studies reported outcomes for the following procedures: cholecystectomy, colectomy, appendectomy, small bowel resection, peptic ulcer repair, adhesiolysis, laparotomy, and hernia repair. Eight studies (2,358,093 patients) with available data were included in the meta-analysis. Low hospital volume was not significantly associated with higher complications. In the sensitivity analysis, low hospital volume was significantly associated with higher complications when appropriate heterogeneity was achieved. Low surgeon volume was associated with higher complications, and these findings remained consistent in the sensitivity analysis.

CONCLUSION

We found that hospital and surgeon volume was significantly associated with higher complications in patients undergoing emergency intra-abdominal surgery when appropriate heterogeneity was achieved.

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Alberga AJ, de Bruin JL, Bastos Gonçalves F, Karthaus EG, Wilschut JA, van Herwaarden JA, Wever JJ, Verhagen HJM. Nationwide Outcomes of Octogenarians Following Open or Endovascular Management After Ruptured Abdominal Aortic Aneurysms. J Endovasc Ther 2023;30:419-432. [PMID: 35311414 PMCID: PMC10209502 DOI: 10.1177/15266028221083460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]

Abstract

PURPOSE

Octogenarians are known to have less-favorable outcomes following ruptured abdominal aortic aneurysm (rAAA) repair compared with their younger counterparts. Accurate information regarding perioperative outcomes following rAAA-repair is important to evaluate current treatment practice. The aim of this study was to evaluate perioperative outcomes of octogenarians and to identify factors associated with mortality and major complications after open surgical repair (OSR) or endovascular aneurysm repair (EVAR) of a rAAA using nationwide, real-world, contemporary data.

METHODS

All patients that underwent EVAR or OSR of an infrarenal or juxtarenal rAAA between January 1, 2013, and December 31, 2018, were prospectively registered in the Dutch Surgical Aneurysm Audit (DSAA) and included in this study. The primary outcome was the comparison of perioperative outcomes of octogenarians versus non-octogenarians, including adjustment for confounders. Secondary outcomes were the identification of factors associated with mortality and major complications in octogenarians.

RESULTS

The study included 2879 patients, of which 1146 were treated by EVAR (382 octogenarians, 33%) and 1733 were treated by OSR (410 octogenarians, 24%). Perioperative mortality of octogenarians following EVAR was 37.2% versus 14.8% in non-octogenarians (adjusted OR=2.9, 95% CI=2.8-3.0) and 50.0% versus 29.4% following OSR (adjusted OR=2.2, 95% CI=2.2-2.3). Major complication rates of octogenarians were 55.4% versus 31.8% in non-octogenarians following EVAR (OR=2.7, 95% CI=2.1-3.4), and 68% versus 49% following OSR (OR=2.2, 95% CI=1.8-2.8). Following EVAR, 30.6% of the octogenarians had an uncomplicated perioperative course (UPC) versus 49.5% in non-octogenarians (OR=0.5, 95% CI=0.4-0.6), while following OSR, UPC rates were 20.7% in octogenarians versus 32.6% in non-octogenarians (OR=0.5, 95% CI=0.4-0.7). Cardiac or pulmonary comorbidity and loss of consciousness were associated with mortality and major complications in octogenarians. Interestingly, female octogenarians had lower mortality rates following EVAR than male octogenarians (adjusted OR=0.7, 95% CI=0.6-0.8).

CONCLUSION

Based on this nationwide study with real-world registry data, mortality rates of octogenarians following ruptured AAA-repair were high, especially after OSR. However, a substantial proportion of these octogenarians following OSR and EVAR had an uneventful recovery. Known preoperative factors do influence perioperative outcomes and reflect current treatment practice.

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Elfrink AKE, Alberga AJ, van Berge Henegouwen MI, Scheurs WH, van der Geest LGM, Verhagen HJM, Dekker JWT, Grünhagen DJ, Wouters MWJM, Klaase JM. Outcomes After Major Surgical Procedures in Octogenarians: A Nationwide Cohort Study. World J Surg 2022;46:2399-2408. [PMID: 35927369 PMCID: PMC9436861 DOI: 10.1007/s00268-022-06642-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 11/25/2022]

Abstract

Introduction

Aging of the worldwide population has been observed, and postoperative outcomes could be worse in elderly patients. This nationwide study assessed trends in number of surgical resections in octogenarians regarding various major surgical procedures and associated postoperative outcomes.

Methods

All patients who underwent surgery between 2014 and 2018 were included from Dutch nationwide quality registries regarding esophageal, stomach, pancreas, colorectal liver metastases, colorectal cancer, lung cancer and abdominal aortic aneurysms (AAA). For each quality registry, the number of patients who were 80 years or older (octogenarians) was calculated per year. Postoperative outcomes were length of stay (LOS), 30 day major morbidity and 30 day mortality between octogenarians and younger patients.

Results

No increase in absolute number and proportion of octogenarians that underwent surgery was observed. Median LOS was higher in octogenarians who underwent surgery for colorectal cancer, colorectal liver metastases, lung cancer, pancreatic disease and esophageal cancer. 30 day major morbidity was higher in octogenarians who underwent surgery for colon cancer, esophageal cancer and elective AAA-repair. 30 day mortality was higher in octogenarians who underwent surgery for colorectal cancer, lung cancer, stomach cancer, pancreatic disease, esophageal cancer and elective AAA-repair. Median LOS decreased between 2014 and 2018 in octogenarians who underwent surgery for stomach cancer and colorectal cancer. 30 day major morbidity decreased between 2014 and 2018 in octogenarians who underwent surgery for colon cancer. No trends were observed in octogenarians regarding 30 day mortality between 2014 and 2018.

Conclusion

No increase over time in absolute number and proportion of octogenarians that underwent major surgery was observed in the Netherlands. Postoperative outcomes were worse in octogenarians.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00268-022-06642-6.

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Alberga AJ, Karthaus EG, Wilschut JA, de Bruin JL, Akkersdijk GP, Geelkerken RH, Hamming JF, Wever JJ, Verhagen HJM. Treatment Outcome Trends for Non-Ruptured Abdominal Aortic Aneurysms: A Nationwide Prospective Cohort Study. Eur J Vasc Endovasc Surg 2022;63:275-283. [PMID: 35027275 DOI: 10.1016/j.ejvs.2021.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/19/2021] [Accepted: 08/15/2021] [Indexed: 11/03/2022]

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.

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Center Volume is Associated with Diminished Failure to Rescue and Improved Outcomes Following Elective Open AAA Repair. J Vasc Surg 2022;76:400-408.e2. [DOI: 10.1016/j.jvs.2021.12.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/30/2021] [Indexed: 01/02/2023]

Alberga AJ, von Meijenfeldt GCI, Rastogi V, de Bruin JL, Wever JJ, van Herwaarden JA, Hamming JF, Hazenberg CEVB, van Schaik J, Mees BME, van der Laan MJ, Zeebregts CJ, Schurink GWH, Verhagen HJM. Association of Hospital Volume with Perioperative Mortality of Endovascular Repair of Complex Aortic Aneurysms: A Nationwide Cohort Study. Ann Surg 2021;277:00000658-900000000-93144. [PMID: 34913891 DOI: 10.1097/sla.0000000000005337] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]

Rao A, Mehta A, Lazar AN, Siracuse J, Garg K, Schermerhorn M, Takayama H, Patel VI. The Association Between Preoperative Independent Ambulatory Status and Outcomes After Open Abdominal Aortic Aneurysm Repairs. Ann Vasc Surg 2021;81:70-78. [PMID: 34785339 DOI: 10.1016/j.avsg.2021.10.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 12/20/2022]

Abstract

OBJECTIVE

Preoperative functional status is appreciated as a key determinant of decision-making when evaluating patients for complex elective surgeries. We used the Vascular Quality Initiative (VQI) to analyze the effect of being able to independently ambulate on outcomes after open abdominal aortic aneurysm (AAA) repairs.

METHODS

We identified all patients who underwent elective or urgent open AAA repairs from January 2013 to August 2019 in the VQI registry. We recorded demographic variables, comorbidities, and operative factors such as approach, operative ischemia time, proximal clamp site, and presence of iliac aneurysms. Short-term and long-term outcomes included 30-day mortality, any perioperative complications, failure to rescue (defined as death after a complication), and one-year all-cause mortality. We dichotomized patients based on their ability to independently ambulate (Ambulatory) or inability to ambulate independently (Non-Ambulatory) and used both multivariable logistic regressions and cox-proportional hazards models to evaluate outcomes.

RESULTS

Of 5,371 patients, 328 (6.1%) could not ambulate independently and were more likely to be older (median age 69 vs 72), female (25% vs. 38%), and have greater comorbidities. Overall outcomes were: 4.3% for 30-day mortality, 38.7% for complications, 10.2% for failure-to-rescue, and 6.9% for one-year mortality. Univariate analysis showed higher rates of all adverse outcomes in non-ambulatory patients. On adjusted analysis, non-ambulatory patients had increased odds of complications by 46% (OR 1.46 [95%-CI 1.11-1.91]) and one-year mortality by 46% (HR 1.46 [95%-CI 1.06-1.99]), but not failure to rescue (OR 1.05 [95%-CI 0.67-1.62]) or 30-day mortality (OR 1.22 [95%-CI 0.82-1.81]). Increased hospital volume, age, and increased operative renal ischemia time were independently associated with adverse outcomes.

CONCLUSIONS

Non-ambulatory status was observed in a small percentage of patients undergoing open AAA repair but was associated with higher rates of post-operative complications and one-year mortality. Ambulatory capacity is one of the key determinants of outcomes following open AAA repair. In patients with poor ambulatory function, a conservative approach is highly recommended over invasive open surgical intervention.

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Association between Hospital Volume and Failure to Rescue after Open or Endovascular Repair of Intact Abdominal Aortic Aneurysms in the VASCUNET and International Consortium of Vascular Registries. Ann Surg 2021;274:e452-e459. [PMID: 34225297 DOI: 10.1097/sla.0000000000005044] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]

Abstract

OBJECTIVE

To investigate the association between hospital volume and failure to rescue (FtR), after open (OAR) and endovascular (EVAR) repair of intact abdominal aortic aneurysms (AAA) among centers participating in the VASCUNET and International Consortium of Vascular Registries (ICVR).

SUMMARY BACKGROUND DATA

FtR (i.e., in-hospital death following major complications) is a composite end-point representing the inability to treat complications effectively and prevent death.

METHODS

Using data from eight vascular registries, complication and mortality rates after intact AAA repair were examined (n = 60,273; EVAR-43,668; OAR-16,605). A restricted analysis using pooled data from four countries (Australia, Hungary, New Zealand, USA) reporting data on all postoperative complications (bleeding, stroke, cardiac, respiratory, renal, colonic ischemia) was performed to identify risk-adjusted association between hospital volume and FtR.

RESULTS

The most frequently reported complications were cardiac (EVAR-3.0%, OAR-8.9%) and respiratory (EVAR-1.0%, OAR-5.7%). In adjusted analysis, 4.3% of EVARs and 18.5% of OARs had at least one complication. The overall FtR rate was 10.3% after EVAR and 15.7% after OAR. Subjects treated in the highest volume centers(Q4) had 46% and 80% lower odds of FtR after EVAR (OR = 0.54; 95%CI = 0.34-0.87;p = 0.04) and OAR (OR = 0.22; 95%CI = 0.11-0.44;p < 0.001) when compared to lowest volume centers(Q1), respectively. Colonic ischemia had the highest risk of FtR for both procedures (adjusted predicted risks, EVAR: 27%, 95%CI 14%-45%; OAR: 30%, 95%CI 17%-46%).

CONCLUSIONS

In this multi-national dataset, FtR rate after intact AAA repair with EVAR and OAR is significantly associated with hospital volume. Hospitals in the top volume quartiles achieve the lowest mortality after a complication has occurred.

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von Meijenfeldt GCI, Alberga AJ, Balm R, Vahl AC, Verhagen HJM, Blankensteijn JD, Zeebregts CJ, van der Laan MJ. Results from a nationwide prospective registry on open surgical or endovascular repair of juxtarenal abdominal aortic aneurysms. J Vasc Surg 2021;75:81-89.e5. [PMID: 34197942 DOI: 10.1016/j.jvs.2021.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 06/11/2021] [Indexed: 10/21/2022]

Abstract

BACKGROUND

Juxtarenal abdominal aortic aneurysms (JRAAA) can be treated either with open surgical repair (OSR) including suprarenal clamping or by complex endovascular aneurysm repair (cEVAR). In this study we present the comparison between the short-term mortality and complications of the elective JRAAA treatment modalities from a national database reflecting daily practice in the Netherlands.

METHODS

All patients undergoing elective JRAAA open repair or cEVAR (fenestrated EVAR or chimney EVAR) between January 2016 and December 2018 registered in the Dutch Surgical Aneurysm Audit (DSAA) were eligible for inclusion. Descriptive perioperative variables and outcomes were compared between patients treated with open surgery or endovascularly. Adjusted odds ratios for short-term outcomes were calculated by logistic regression analysis.

RESULTS

In all, 455 primary treated JRAAA patients could be included (258 OSR, 197 cEVAR). Younger patients and female patients were treated more often with OSR vs cEVAR (72±6.1 vs. 76±6.0, p<0.001, 22% vs 15%, p=0.047, respectively). Patients treated with OSR had significantly more major and minor complications as well as a higher chance of early mortality (OSR: cEVAR, 45% vs. 21%, p<0.001; 34% vs. 23%, p =0.011; 6.6% vs. 2.5%, p=0.046, respectively). After logistic regression with adjustment for confounders, patients who were treated with OSR showed an odds ratio of 3.64 (95%CI 2.25-5.89, p<0.001) for major complications compared to patients treated with cEVAR and for minor complications the odds ratios were 2.17 (95%CI 1.34-3.53, p=0.002) higher. For early mortality the odds ratios were 3.79 (95%CI 1.26-11.34, p=0.017) higher after OSR compared to cEVAR.

CONCLUSION

In this study, after primary elective OSR for JRAAA the odds for major complications, minor complications, and short-term mortality were significantly higher compared to cEVAR.

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Alberga AJ, Karthaus EG, van Zwet EW, de Bruin JL, van Herwaarden JA, Wever JJ, Verhagen HJM. Outcomes in Octogenarians and the Effect of Comorbidities After Intact Abdominal Aortic Aneurysm Repair in the Netherlands: A Nationwide Cohort Study. Eur J Vasc Endovasc Surg 2021;61:920-928. [PMID: 33875325 DOI: 10.1016/j.ejvs.2021.02.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 02/05/2021] [Accepted: 02/23/2021] [Indexed: 10/21/2022]

Abstract

OBJECTIVE

Age is an independent risk factor for mortality after both elective open surgical repair (OSR) and endovascular aneurysm repair (EVAR). As a result of an ageing population, and the less invasive nature of EVAR, the number of patients over 80 years (octogenarians) being treated is increasing. The mortality and morbidity following aneurysm surgery are increased for octogenarians. However, the mortality for octogenarians who have either low or high peri-operative risks remains unclear. The aim of this study was to provide peri-operative outcomes of octogenarians vs. non-octogenarians after OSR and EVAR for intact aneurysms, including separate subanalyses for elective and urgent intact repair, based on a nationwide cohort. Furthermore, the influence of comorbidities on peri-operative mortality was examined.

METHODS

All patients registered in the Dutch Surgical Aneurysm Audit (DSAA) undergoing intact AAA repair between 2013 and 2018, were included. Patient characteristics and peri-operative outcomes (peri-operative mortality, and major complications) of octogenarians vs. non-octogenarians for both OSR and EVAR were compared using descriptive statistics. Multivariable logistic regression analyses were used to examine whether age and the presence of cardiac, pulmonary, or renal comorbidities were associated with mortality.

RESULTS

This study included 12 054 EVAR patients (3 015 octogenarians), and 3 815 OSR patients (425 octogenarians). Octogenarians in both the EVAR and OSR treatment groups were more often female and had more comorbidities. In both treatment groups, octogenarians had significantly higher mortality rates following intact repair as well as higher major complication rates. Mortality rates of octogenarians were 1.9% after EVAR and 11.8% after OSR. Age ≥ 80 and presence of cardiac, pulmonary, and renal comorbidities were associated with mortality after EVAR and OSR.

CONCLUSION

Because of the high peri-operative mortality rates of octogenarians, awareness of the presence of comorbidities is essential in the decision making process before offering aneurysm repair to this cohort, especially when OSR is considered.

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Peacock O, Yanni F, Kuryba A, Cromwell D, Lockwood S, Anderson I, Vohra RS. Failure to rescue patients after emergency laparotomy for large bowel perforation: analysis of the National Emergency Laparotomy Audit (NELA). BJS Open 2021;5:zraa060. [PMID: 33609399 PMCID: PMC7896807 DOI: 10.1093/bjsopen/zraa060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/01/2020] [Indexed: 12/03/2022] Open

Abstract

BACKGROUND

Past studies have highlighted variation in in-hospital mortality rates among hospitals performing emergency laparotomy for large bowel perforation. The aim of this study was to investigate whether failure to rescue (FTR) contributes to this variability.

METHODS

Patients aged 18 years or over requiring surgery for large bowel perforation between 2013 and 2016 were extracted from the National Emergency Laparotomy Audit (NELA) database. Information on complications were identified using linked Hospital Episode Statistics data and in-hospital deaths from the Office for National Statistics. The FTR rate was defined as the proportion of patients dying in hospital with a recorded complication, and was examined in hospitals grouped as having low, medium or high overall postoperative mortality.

RESULTS

Overall, 6413 patients were included with 1029 (16.0 per cent) in-hospital deaths. Some 3533 patients (55.1 per cent) had at least one complication: 1023 surgical (16.0 per cent) and 3332 medical (52.0 per cent) complications. There were 22 in-hospital deaths following a surgical complication alone, 685 deaths following a medical complication alone, 150 deaths following both a surgical and medical complication, and 172 deaths with no recorded complication. The risk of in-hospital death was high among patients who suffered either type of complication (857 deaths in 3533 patients; FTR rate 24.3 per cent): 172 deaths followed a surgical complication (FTR-surgical rate 16.8 per cent) and 835 deaths followed a medical complication (FTR-medical rate of 25.1 per cent). After adjustment for patient characteristics and hospital factors, hospitals grouped as having low, medium or high overall postoperative mortality did not have different FTR rates (P = 0.770).

CONCLUSION

Among patients having emergency laparotomy for large bowel perforation, efforts to reduce the risk of in-hospital death should focus on reducing avoidable complications. There was no evidence of variation in FTR rates across National Health Service hospitals in England.

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Osho AA, Bishawi MM, Heng EE, Orubu E, Amardey-Wellington A, Villavicencio MA, Funamoto M. Failure to rescue in the era of the lung allocation score: The impact of center volume. Am J Surg 2020;220:793-799. [PMID: 31982094 DOI: 10.1016/j.amjsurg.2020.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 12/28/2019] [Accepted: 01/13/2020] [Indexed: 11/24/2022]

van Laarhoven CJHCM, van Setten J, van Herwaarden JA, Pasterkamp G, de Kleijn DPV, de Borst GJ, van der Laan SW. Polygenic Susceptibility of Aortic Aneurysms Associates to the Diameter of the Aneurysm Sac: the Aneurysm-Express Biobank Cohort. Sci Rep 2019;9:19844. [PMID: 31882626 PMCID: PMC6934821 DOI: 10.1038/s41598-019-56230-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/08/2019] [Indexed: 11/23/2022] Open

Lazarides MK, Baktiroglu S, Georgiadis GS. Failure to save (FTS): A proposed new index of performance quality in access surgery. J Vasc Access 2019;21:399. [DOI: 10.1177/1129729819877779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open

Osho AA, Bishawi MM, Mulvihill MS, Axtell AL, Hirji SA, Spencer PJ, Heng EE, D'Alessandro DA, Melnitchouk S, Hartwig MG, Villavicencio MA. Failure to Rescue Contributes to Center-Level Differences in Mortality After Lung Transplantation. Ann Thorac Surg 2019;109:218-224. [PMID: 31470009 DOI: 10.1016/j.athoracsur.2019.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 06/26/2019] [Accepted: 07/05/2019] [Indexed: 11/18/2022]

Abstract

BACKGROUND

The clinical response to postoperative complications after lung transplantation (LTx) may contribute to mortality differences among transplantation centers. The ability to avoid mortality after a complication-failure to rescue (FTR)-may be an effective quality metric in LTx.

METHODS

The United Network for Organ Sharing database was queried for adult, first-time, lung-only transplantations from May 2005 to December 2015. Transplantation centers were stratified into equal-sized terciles on the basis of observed operative mortality rates. Several postoperative complications were identified, including stroke, acute rejection, acute kidney injury requiring hemodialysis, airway dehiscence, and extracorporeal membrane oxygenation 72 hours after surgery. Rates of FTR were calculated as the number of operative mortalities in patients who had complications divided by the number of patients who had any postoperative complications.

RESULTS

Our study population included 16,411 LTx operations performed at 69 transplantation centers. LTx centers were stratified into terciles with average perioperative mortality of 4.0% for low-mortality centers, 6.9% for intermediate-mortality centers, and 12.4% for high-mortality centers. Low-mortality centers had slightly lower complication rates (low, 15.0% vs intermediate, 17.1% vs high, 19.1%; P < .001). Differences in FTR rate were significantly more pronounced (low, 14.9% vs intermediate, 23.9% vs high, 34.2%; P < .001). Multivariable logistic regression and generalized linear models demonstrated an independent association between high FTR rates and high mortality in LTx (P < .001).

CONCLUSIONS

Differences in rates of FTR contribute significantly to per-center variability in mortality after LTx. FTR can serve as a quality metric to identify opportunities for improvement in management of perioperative adverse events.

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Reyes Valdivia A, Álvarez Marcos F, Duque Santos Á, Ocaña Guaita J, Gandarias Zúñiga C. Expanded Suitability of Ruptured Abdominal Aortic Aneurysms for Total Endovascular Repair Using the Endurant Endograft and Heli-FX EndoAnchors. J Endovasc Ther 2019;26:245-249. [DOI: 10.1177/1526602819828377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]

Abstract Purpose: To assess if the suitability of endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs) can be expanded by combining the Endurant stent-graft with the Heli-FX EndoAnchors. Materials and Methods: Contrast-enhanced computed tomography (CT) scans of 90 patients (mean age 73.2±9 years; 87 men) with RAAA admitted between January 2014 and January 2018 in 2 tertiary care centers were analyzed in a 3-dimensional workstation. Anatomical features of the aneurysms according to the instructions for use (IFU) for the Endurant endograft were evaluated and expansion of treatment with Heli-FX EndoAnchors was assessed. Results: Neck length <10 mm was present in 41 (45.6%) patients; 5 had neck diameters outside the IFU and 45 (50.0%) had conical necks. Thrombus and calcium were absent in 63 (70.0%) and 73 (81.1%), respectively. In the study cohort, 44 (48.9%) patients met all the neck criteria, although overall IFU compliance was found in only 35 (38.9%) patients due to iliac-related issues in 21 patients. The adjunctive use of EndoAnchors in the entire study group would enhance the therapeutic range to an additional 24 patients, 8 of whom would need an associated iliac procedure. This represents an expansion of the total EVAR approach from 48.9% to 75.6% of cases if some iliac issues are overcome and from 38.9% to 56.7% without correcting iliac deficiencies. Conclusion: The main reason of being unfit for endovascular treatment in this series was neck length <10 mm. Based on this analysis, nearly 40% of RAAA patients would have been candidates for EVAR based on the IFU neck criteria for the Endurant stent-graft. This suitability could be nearly doubled with the use of EndoAnchors and correction of unsuitable iliac anatomy. The use of EndoAnchors has the potential to offer a significant benefit in the endovascular treatment of RAAA patients. Collapse

Archie JP. Failure to Rescue for Abdominal Aortic Aneurysm Surgery - An Enigma Explained? Eur J Vasc Endovasc Surg 2018;56:662. [PMID: 30093177 DOI: 10.1016/j.ejvs.2018.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]