Trends in elective and ruptured abdominal aortic aneurysm repair by practice setting in Ontario, Canada, from 2003 to 2016: a population-based time-series analysis

Abstract

Background: Recent years have seen centralization of vascular surgery services in Ontario. We sought to examine the trends in overall and approach-specific elective and ruptured abdominal aortic aneurysm repair by hospital type (teaching v. community). Methods: We conducted a population-based time-series analysis of elective and ruptured abdominal aortic aneurysm repairs in Ontario, Canada, from 2003 to 2016. Quarterly cumulative incidences of repairs per 100 000 Ontarians aged 40 years and older were calculated. We fit exponential smoothing models to the data stratified by approach and hospital type to examine repair trends. Results: We identified 19 219 elective and 2722 ruptured repairs between 2003 and 2016. The cumulative incidences of overall elective repair and elective open surgical repair decreased by 1.15% (p = 0.008) and 67% (p < 0.001), respectively, in teaching hospitals and by 23% (p < 0.001) and 60% (p < 0.001), respectively, in community hospitals. The cumulative incidence of elective endovascular repair increased 667% in teaching hospitals (p < 0.001). Elective endovascular repair began in community centres after 2010 and increased to 0.98/100 000 (p < 0.001), resulting in a rebound in overall elective repair in the community. Overall ruptured repairs and ruptured open repairs decreased by 84% (p < 0.001) and 88% (p = 0.002), respectively, at community hospitals. Ruptured endovascular repairs at community hospitals increased from no procedures before 2006 to 0.03/100 000 in 2016 (p = 0.005). Interpretation: There has been substantial uptake of endovascular aortic repair in teaching and community hospitals in Ontario, and community hospital uptake of endovascular repair has begun decentralization of abdominal aortic aneurysm repair. Increased experience and training in endovascular repair and reduced specialized care requirements will probably lead to continued decentralization.

One-time screening for abdominal aortic aneurysm in Ontario, Canada: a model-based cost-utility analysis

“…In 2018, patients in Ontario waited about 42 days between vascular surgeon consultation and receiving scheduled AAA repairs. 14 Lastly, although more AAA-related deaths may be averted, compared with unnecessary lives lost during a scheduled repair (e.g., patient with AAA diagnosed through screening who would never have experienced a rupture but who dies during surgery), such a utilitarian lens may be acceptable only at the population level, rather than at the individual patient level. 44 Thus, patients’ perspectives must be considered in developing screening programs.…”

“…11 , 12 Canadian cost-effectiveness analyses are outdated since they are based on data more than 15 years old and did not consider endovascular aneurysm repair, which has become more common than open AAA repair. 13 , 14 Another contributory knowledge gap is the unknown prevalence of AAA in Canada. The impact of screening programs implemented internationally has been undermined by the lower-than-expected prevalence of AAA identified among people attending screening programs.…”

Type IA endoleak caused by interlocked suprarenal bare-metal stents after endovascular abdominal aortic aneurysm repair with successful endovascular rescue

“…4,5 The EVAR 1, 6 Dutch Randomized Endovascular Aneurysm Management (DREAM), 7 and Open Versus Endovascular Repair (OVER) 8 trials demonstrated superior perioperative morbidity and mortality for patients undergoing EVAR compared with open repair of AAA, which has led to a significant uptake in the use of EVAR. 9 Long-term follow-up suggests that the survival benefit from EVAR is lost, 2 and in high-risk patients ineligible for open repair, any reduction in aneurysm-related mortality is lost among the overall high all-cause mortality rate in this population, 10 indicating that careful selection of patients is required. Our patient was 90 years old but with excellent functional capacity.…”

Risk factors for readmission after open abdominal aortic aneurysms repair and its outcome in chronic kidney disease patients

“…4 Since that time, there has been an exponential increase in aneurysms repaired with endovascular techniques. 5,6 This is largely explained by the reduced hospital length of stay, short term morbidity and mortality associated with endovascular repair. 7 The 2-year survival is comparable with both repair techniques.…”