Hospitalization Rates and Post-Operative Mortality for Abdominal Aortic Aneurysm in Italy over the Period 2000–2011

Abstract

BackgroundRecent studies have reported declines in incidence, prevalence and mortality for abdominal aortic aneurysms (AAAs) in various countries, but evidence from Mediterranean countries is lacking. The aim of this study is to examine the trend of hospitalization and post-operative mortality rates for AAAs in Italy during the period 2000–2011, taking into account the introduction of endovascular aneurysm repair (EVAR) in 1990s.MethodsThis retrospective cohort study was carried out in Emilia-Romagna, an Italian region with 4.5 million inhabitants. A total of 19,673 patients hospitalized for AAAs between 2000 and 2011, were identified from the hospital discharge records (HDR) database. Hospitalization rates, percentage of OSR and EVAR and 30-day mortality rates were calculated for unruptured (uAAAs) and ruptured AAAs (rAAAs).ResultsAdjusted hospitalization rates decreased on average by 2.9% per year for uAAAs and 3.2% for rAAAs (p<0.001). The temporal trend of 30-day mortality rates remained stable for both groups. The percentage of EVAR for uAAAs increased significantly from 2006 to 2011 (42.7 versus 60.9% respectively, mean change of 3.9% per year, p<0.001). No significant difference in mortality was found between OSR and EVAR for uAAAs and rAAAs.ConclusionsThe incidence and trend of hospitalization rates for rAAAs and uAAAs decreased significantly in the last decade, while 30-day mortality rates in operated patients remained stable. OSR continued to be the most common surgery in rAAAs, although the gap between OSR and EVAR recently declined. The EVAR technique became the preferred surgery for uAAAs since 2008.

Clinical outcomes of infrarenal abdominal aortic aneurysms that underwent endovascular repair in a district general hospital

“…EVAR has expanded access to repair because ruptures may have been prevented, particularly for oldest patients, and life expectancy may have been prolonged meaningfully (3). These patients in previous studies were older men and had higher rates of hypertension and COPD; they were more likely to undergo elective EVAR rather than emergent EVAR and were comparable with the patients in our present report (7,8,12). A history of hypertension strongly predicted survival of EVAR (8,13).…”

“…However, it is crucial to consider, first, that the use of endovascular repair for rAAA increased from 13% in 2002 to 73% in 2013; and second, that the demographic trend has been moving toward an increasing incidence and prevalence of cardiovascular disease in elderly men (4,8). In some reports, the mean age was 70-75 years, with over 78-90% of the patients being men (7,(9)(10)(11). Although rAAAs are more common in male patients, rAAAs in female patients are accompanied by more advanced atherosclerotic processes and more severe cardiovascular disorders (9).…”

National trends in incidence and outcomes of abdominal aortic aneurysm among elderly type 2 diabetic and non-diabetic patients in Spain (2003–2012)

“…In Italy, Sensi et al . indicated that when they focused on elderly patients (aged 75 years or more) hospitalization rates increased over time and explain this trend as a delayed clinical onset of illness, resulting from the combined effect of genetic factors and the decrease of smoking [ 26 ]. In US, Mureebe et al .…”

“…Sensi et al . indicated that EVAR technique became the preferred method for AAAs since 2008 and the advantage of this surgical procedure is that it requires shorter hospitalizations, although is more costly [ 26 ].…”

Results from the Multicenter Study on Aortoenteric Fistulization After Stent Grafting of the Abdominal Aorta (MAEFISTO)

“…With advancements in stent graft technology and design, along with documented improvements in operators' experience and worldwide scientific evidence, endovascular repair of abdominal aortic aneurysm (AAA) disease has become the most commonly used approach for AAA repair in Italy, 1 as in most countries worldwide. 2 Although considered equally effective and less invasive than open surgical repair, endovascular AAA repair (EVAR) is known to be associated with early and late procedure-related complications, 3 including endoleak, migration, strut fractures, kinking, material fatigue, access-site sequelae, graft limb occlusion, stent graft infection, and aortoenteric fistulization (AEF).…”