Comparative analysis of the outcomes of elective abdominal aortic aneurysm repair in England and Sweden

Abstract

BackgroundThere is substantial international variation in mortality after abdominal aortic aneurysm (AAA) repair; many non‐operative factors influence risk‐adjusted outcomes. This study compared 90‐day and 5‐year mortality for patients undergoing elective AAA repair in England and Sweden.MethodsPatients were identified from English Hospital Episode Statistics and the Swedish Vascular Registry between 2003 and 2012. Ninety‐day mortality and 5‐year survival were compared after adjustment for age and sex. Separate within‐country analyses were performed to examine the impact of co‐morbidity, hospital teaching status and hospital annual caseload.ResultsThe study included 36 249 patients who had AAA treatment in England, with a median age of 74 (i.q.r. 69–79) years, of whom 87·2 per cent were men. There were 7806 patients treated for AAA in Sweden, with a median of age 73 (68–78) years, of whom 82·9 per cent were men. Ninety‐day mortality rates were poorer in England than in Sweden (5·0 versus 3·9 per cent respectively; P < 0·001), but were not significantly different after 2007. Five‐year survival was poorer in England (70·5 versus 72·8 per cent; P < 0·001). Use of EVAR was initially lower in England, but surpassed that in Sweden after 2010. In both countries, poor outcome was associated with increased age. In England, institutions with higher operative annual volume had lower mortality rates.ConclusionMortality for elective AAA repair was initially poorer in England than Sweden, but improved over time alongside greater uptake of EVAR, and now there is no difference. Centres performing a greater proportion of EVAR procedures achieved better results in England.

The Strengths and Limitations of Claims Based Research in Countries With Fee for Service Reimbursement

“…In some instances, it might also be reasonable to determine time trends or evaluate certain group differences by working with claims data from one country and registry data from another. 9,10 Claims have an extraordinarily high external validity when compared with registry data as there is no reimbursement without submitting data to the funder. In addition, there is usually complete follow up until death in the older vascular population that are universally covered in most developed countries.…”

Prevalence and natural history of and risk factors for subaneurysmal aorta among 65-year-old men

“…Ruptured AAA is, to date, more common in subjects older than 75 years of age, and the expectation for intervention in older patients has increased (7,36,37). Rapid acquisition of minimally invasive technologies, such as endovascular aneurysm repair (EVAR), and the ability to intervene have also increased (38). Thus, there is an urgent need for the development of evidencebased strategies as to whether the subgroup of individuals with SAA should be monitored or not (39).…”

The Swedish vascular registry Swedvasc 1987–2018

“…Comprehensive clinical data from the registry can be combined with data from governmental registries and thereby provide an important source for research and quality improvement [6][7][8][9][10][11]. Another advantage is the feasibility of collecting data on rare diseases, which for example, has been done for ruptured popliteal artery aneurysms, mycotic aneurysms and vascular injuries [12][13][14][15][16].…”