Editor's Choice – Hospital Incidence, Treatment, and In Hospital Mortality Following Open and Endovascular Surgery for Thoraco-abdominal Aortic Aneurysms in Germany from 2005 to 2014: Secondary Data Analysis of the Nationwide German DRG Microdata

Abstract

WHAT THIS PAPER ADDS Hospital incidence, treatment modality and mortality after surgery for thoraco-abdominal aortic aneurysms (TAAAs) by endovascular or open means on a nationwide level are reported. This analysis reveals that 76% of TAAAs were treated endovascularly in 2014 with increasing frequency over a decade. The in hospital mortality is lower when endovascular repair is performed. High annual caseload is significantly associated with decreased in hospital mortality. Rupture, age, and severe comorbidities are associated with worse outcomes.Objective: Hospital incidence, treatment modality, and in hospital mortality after surgery are reported for thoraco-abdominal aortic aneurysms (TAAAs) treated by endovascular or open means in Germany from 2005 to 2014. Methods: Data were extracted from diagnosis related group statistics from the German Federal Statistical Office. All inpatient cases with a diagnosis of ruptured and non-ruptured TAAA (ICD-10 I71.5 and I71.6) and procedure codes for fenestrated or branched endovascular aortic repair (f/bEVAR 5-38a.7x and 5-38a.8x), open aortic repair (OAR 5e384.4), or hybrid procedure (5-384.b/c, 5-38a.a/b/8/80) were included. To adjust for sex, age, medical risk (Elixhauser comorbidity score), type of procedure, and type of admission, a multilevel multivariable regression model with robust error variance was applied. The primary outcome was in hospital mortality; secondary outcomes were organ complications. The relationship between annual hospital volume and outcome was analysed. Results: A total of 2607 cases (406 rTAAA, 2201 nrTAAA) were included. f/bEVAR was performed in 856 cases (32.8%), OAR in 1422 cases (54.5%), and hybrid repair in 354 cases (13.6%). Endovascular repair became more frequent over time (6% in 2005 vs. 76% in 2014 for nrTAAA). Hypertension (75.2%), peripheral artery disease (including abdominal aortic aneurysm, 49.5%), other heart diseases (44.6%), coronary heart disease (30.6%), and renal failure (28.7%) were the most frequently coded comorbidities. The number of hospitals treating TAAAs almost tripled within 9 years. The in hospital mortality was 46.1% for rTAAA and 15.9% for nrTAAA. f/bEVAR (RR 0.35, 0.24e0.51) and high hospital volume (p < .001) were significantly associated with decreased in hospital mortality. Aortic rupture, increasing age, and comorbidity were significantly associated with higher mortality (RR 3.17, 2.45e4.09; 1.52, 1.32e1.76, and 1.05, 1.04e1.06). Conclusions: Seventy-six percent of all TAAAs were treated endovascularly in 2014 with increasing frequency over a decade. In hospital mortality is lower with endovascular repair and in high volume centres. Aortic rupture, age, and severe comorbidities are associated with worse outcomes.

Aneurysms and dissections - What is new in the literature of 2019/2020 - a European Society of Vascular Medicine annual review

“…Perioperative mortality rates were similar [257]. In contrast, data from the German Federal Statistical Office investigating 2,607 cases of ruptured and non-ruptured TAAA In hospital mortality is lower with endovascular repair and in high volume centres [258]. This demonstrates that complex endovascular repair is a highly technical procedure that requires vast experience [259].…”

Discuss Many to Benefit More – Fünf-Jahres-Analyse eines interdisziplinären Aortenkolloquium

“…Andere in ▶ Tab. 6 genannte Gründe, insbesondere die sekundär festgestellte Nichtoperabilität aufgrund einer in diesem Patientengut bekannt hohen Komorbidität [28,29], lassen sich reduzieren. Idealerweise sollte die Vorstellung eines Patienten im iAK nach einer Abklärung der parallel bestehenden Komorbiditäten erfolgen.…”

Balloon-Anchoring Technique to Stabilize Target Vessel Catheterization in Complex Endovascular Aortic Repair

“…Endovascular therapy of abdominal and thoracoabdominal aortic aneurysms (TAAAs) has evolved over the years; currently, over two-thirds of TAAAs are treated endovascularly in Germany. 1 This shift in paradigm was driven by the low mortality and morbidity of endovascular surgery. 2…”