WHAT THIS PAPER ADDS Within the Vascular Quality Initiative, endovascular aortic repair (EVAR) for ruptured infrarenal abdominal aortic aneurysm (rAAA) has been adopted increasingly with favourable short term outcomes in terms of morbidity and mortality as compared with open aortic repair (OAR). Unlike elective AAA repair, a convergence of survival rates between EVAR and OAR in long term follow up for patients who survived the index hospitalisation was not observed, suggesting that the early significant benefits of EVAR are sustained over time and an endovascularfirst strategy in anatomically feasible candidates with rAAA may be associated with long term benefits.Objective: Repair of ruptured infrarenal abdominal aortic aneurysms (rAAA) has shifted from open surgical (OAR) to endovascular (EVAR) over the last decade. However, the long term impact of EVAR vs. OAR for rAAA has not been well described. Methods: Prospectively collected registry data (Vascular Quality Initiative [VQI]) were analysed retrospectively to identify patients who underwent EVAR or OAR for rAAA (2004e2018). The primary outcome was death (in hospital and overall post-discharge). Inverse probability weighting (IPW) was used to adjust for treatment selection. Poisson regression assessed the number of one year post-discharge re-interventions. Results: In total, 4257 patients receiving EVAR (n ¼ 2389 [56%]) or OAR (n ¼ 1868 [44%]) for rAAA were identified. Patients were predominantly male (n ¼ 3310 [77.8%]) with a mean AE standard deviation age of 72.7 AE 9.6 years; most (n ¼ 2449 [59.4%]) presented with haemodynamic instability. Use of EVAR for rAAA increased from 7.8% in 2004 to 67.2% in 2018. After IPW, OAR was associated with a higher odds of in hospital mortality (odds ratio [OR] 1.76, 95% confidence interval [CI] 1.54e2.01; p < .001), which was confirmed after multivariable logistic regression (OR 2.08, 95% CI 1.76e2.45; p < .001). Multivariable Cox proportional hazards showed that OAR was also associated with increased overall post-discharge mortality among all patients (hazard ratio 1.36, 95% CI 1.23e1.51; p < .001). Within weighted treatment groups, five year survival was significantly different (55% for EVAR vs. 46% for OAR; p < .001). OAR showed a significantly higher risk of one year post-discharge re-interventions (incidence rate ratio 2.10, 95% CI 1.52e2.89; p < .001). Conclusion: Within the VQI, EVAR for rAAA repair has been increasingly adopted with favourable short term outcomes in terms of morbidity and mortality, as compared with OAR. Unlike elective AAA repair, survival rates between EVAR and OAR do not converge in long term follow up for patients who survived the index hospitalisation.

OBJECTIVES: It is well documented (Cunnigham et al, 2002) that orthognathic surgery improves quality of life in terms of enhanced oral function, facial aesthetics and wellbeing.Prior to a large multi-centre study performed by Garg et al, 2009 there are no studies that look at operating time and length of in-patient stay for orthognathic procedures.We aimed to compare operative time and length of inpatient stay for in our diverse group of patients against the published data, in addition to assessing readmission/reoperation rate at 7 and 30 days post-operatively. METHODS:Our busy central London Orthognathic Unit treats a diverse selection of patients with complex facial deformity. We devised a 3-year retrospective analysis of 130 patients who underwent (1) routine primary orthognathic surgery; (2) revisional orthognathic surgery and (3) primary orthognathic surgery in Syndromic patientsat University College London Hospital.We collected data from hospital records of all patients who underwent 4 orthognathic procedures; (1) Bimaxillary Osteotomy; (2) Le Fort 1 Osteotomy; (3) Mandible BSSO and (4) Genioplasty. RESULTS:Our data highlights that our operating times and length of in-patient stay for the 3 most common and conventional orthognathic procedures performed in the United Kingdom, is significantly lower compared to the published data to date. CONCLUSIONS:We believe that the results achieved within our Unit reflect a combination of the unique orthognathic protocol, operative technique, and multidisciplinary management employed for all of our patients.There is no doubt that the robust documentation of such data will be an invaluable resource for professional revalidation, clinical governance, healthcare commissioning and safeguarding surgical practice.

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