Skip to main content
SpringerLink
Log in

12 Jahre „Qualitätssicherung BAA“ der DGG

Teil 1: Trends in Therapie und Outcome des nicht rupturierten abdominellen Aortenaneurysmas in Deutschland zwischen 1999 und 2010

Twelve years of the quality assurance registry abdominal aortic aneurysm of the German Vascular Society (DGG)

Part 1: trends in therapy and outcome of non-ruptured abdominal aortic aneurysms in Germany between 1999 and 2010

  • Originalien
  • Published:
Gefässchirurgie Aims and scope Submit manuscript

Zusammenfassung

Zielsetzung

Evaluation der Patientenpopulation, der Behandlungsmodalitäten und des perioperativen Outcomes im Qualitätssicherungsregister „Bauchaortenaneurysma“ der Deutschen Gesellschaft für Gefäßchirurgie und Gefäßmedizin (DGG).

Patienten und Methoden

Zwischen 1999 und 2010 nahmen 201 Kliniken an der freiwilligen Datensammlung teil (1292 Klinikjahre, Median 104 Kliniken/Jahr). Es wurden 36.594 Patienten (offener Aortenersatz/OR, n = 23.307, EVAR n = 13.557) dokumentiert. Veränderungen der Patientenpopulation und der Behandlungsmethoden werden analysiert. Primärer Endpunkt dieser Studie ist die Krankenhausletalität, sekundäre Endpunkte umfassen sonstige perioperative Komplikationen (pulmonal, kardial, operationspflichtige Nachblutungen, Darm- und Glutealischämie, Graftthrombosen/periphere Ischämien, Nierenversagen mit Dialyse, postoperative Sepsis und Endoleckagen). Die Auswertung erfolgt deskriptiv und durch ein logistisches Regressionsmodell.

Ergebnisse

Seit 1999 zeigt sich ein signifikanter Anstieg der endovaskulären Behandlung (p < 0,001). Die mit EVAR behandelten Patienten waren signifikant älter (Durchschnittsalter OR 70 Jahre, EVAR 72,8 Jahre, p < 0,001), insbesondere der Anteil der ≥ 80-jährigen Patienten hat deutlich zugenommen (p < 0,001). Gleichzeitig hat die Krankenhausletalität von 3,1% auf 2,3% abgenommen (p<0,001). Die prozedurale Letalität betrug insgesamt nach OR 3,6%, nach EVAR 1,3% (Odds Ratio 0,28; 95% KI 0,23–0,33; p<0,001), ab dem 80. Lebensjahr stieg die Letalität auf 7,7% bzw. 2,4% (p<0,001) an. In 8.5% aller EVAR‐Prozeduren wurde eine Endoleckage dokumentiert. Alle sonstigen Komplikationen (kardiopulmonal, renal, lokal, Nachblutung, Organischämie) traten nach OR signifikant häufiger auf.

Schlussfolgerungen

Die Registerdaten zeigen eine Zunahme des durchschnittlichen Patientenalters und einen deutlichen Trend zur endovaskulären Behandlung des AAA. Diese ist mit einer geringeren Krankenhausletalität und perioperativen Komplikationsrate verbunden.

Abstract

Objective

The aim of the study was an evaluation of patient populations, treatment modalities and perioperative outcomes in the quality assurance registry abdominal aortic aneurysm of the German Vascular Society (DGG).

Patients and methods

Between 1999 and 2010 a total of 201 hospitals participated in the voluntary registry (1,292 clinic years and median 104 clinics/year). Overall 36,594 cases (open repair OR, n = 23,037, endovascular aneurysm repair EVAR, n = 13,557) have been documented and analyzed with respect to changes in the type of treatment and patient population. The primary endpoint was in-hospital mortality and secondary endpoints were perioperative complications (e.g. cardiac, pulmonary, bleeding requiring intervention, bowel and gluteal ischemia, thrombosis of graft and peripheral ischemia, renal failure with need for dialysis, postoperative sepsis and endoleaks). The data were analyzed descriptively and by a logistic regression model.

Results

Since 1999 a significant increase of endovascular treatment was observed (p < 0.001). Patients treated with EVAR were significantly older (mean age OR 70 years, EVAR 72.8 years, p < 0.001). In particular the proportion of patients ≥ 80 years undergoing EVAR increased (p < 0.001). Simultaneously a decrease of in‐hospital mortality from 3.1% to 2.3% was observed (p < <0.001). In particular, the proportion of patients > 80 years undergoing EVAR increased (p < <0.001). In‐hospital mortality was 1.3% after EVAR compared to 3.6% after OR (odd ratio 0.279, 95% CI 0.234 to 0.333, p < 0.001). In patients > 80 years, perioperative mortality increased to 7.7% vs. 2.4% (p < 0,001). Besides endoleaks in 8.5% after EVAR, all systemic and local complications were more prevalent after OR.

Conclusions

The data clearly show an increase in the average patient age and a clear trend towards endovascular treatment of abdominal aortic aneurysms which was associated with fewer perioperative complications and mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

  1. Barnes M, Boult M, Maddern G et al (2008) A model to predict outcomes for endovascular aneurysm repair using preoperative variables. Eur J Vasc Endovasc Surg 35:571–579

    Article  PubMed  CAS  Google Scholar 

  2. Blankensteijn JD, De Jong SE, Prinssen M et al (2005) Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med 352:2398–2405

    Article  PubMed  CAS  Google Scholar 

  3. Brady AR, Fowkes FGR, Greenhalgh RM et al (2000) Risk factors for postoperative death following elective surgical repair of abdominal aortic aneurysm: results from the UK small aneurysm trial. Br J Surg 87:742–749

    Article  PubMed  CAS  Google Scholar 

  4. De Bruin JL, Baas AF, Buth J et al (2010) Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med 362:1881–1889

    Article  Google Scholar 

  5. Drury D, Michaels JA, Jones L et al (2005) Systematic review of recent evidence for the safety and efficacy of elective endovascular repair in the management of infrarenal abdominal aortic aneurysm. Br J Surg 92:937–946

    Article  PubMed  CAS  Google Scholar 

  6. Eckstein HH, Bruckner T, Heider P et al (2007) The relationship between volume and outcome following elective open repair of Abdominal Aortic Aneurysms (AAA) in 131 German hospitals. Eur J Vasc Endovasc Surg 34:260–266

    Article  PubMed  Google Scholar 

  7. Giles KA, Schermerhorn ML, O’malley AJ et al (2009) Risk prediction for perioperative mortality of endovascular vs open repair of abdominal aortic aneurysms using the Medicare population. J Vasc Surg 50:256–262

    Article  PubMed  Google Scholar 

  8. Grant SW, Grayson AD, Purkayastha D et al (2011) Logistic risk model for mortality following elective abdominal aortic aneurysm repair. Br J Surg 98:652–658

    Article  PubMed  CAS  Google Scholar 

  9. Greenhalgh RM (2004) Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 364:843–848

    Article  PubMed  CAS  Google Scholar 

  10. Greenhalgh RM, Brown LC, Kwong GP et al (2004) Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 364:843–848

    Article  PubMed  CAS  Google Scholar 

  11. Greenhalgh RM, Brown LC, Powell JT et al (2010) Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 362:1863–1871

    Article  PubMed  Google Scholar 

  12. Henebiens M, Vahl A, Koelemay MJ (2008) Elective surgery of abdominal aortic aneurysms in octogenarians: a systematic review. J Vasc Surg 47:676–681

    Article  PubMed  Google Scholar 

  13. Lederle FA, Freischlag JA, Kyriakides TC et al (2009) Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA 302:1535–1542

    Article  PubMed  CAS  Google Scholar 

  14. Mani K, Lees T, Beiles B et al (2011) Treatment of abdominal aortic aneurysm in nine countries 2005–2009: a vascunet report. Eur J Vasc Endovasc Surg 42:598–607

    Article  PubMed  CAS  Google Scholar 

  15. Prenner SB, Turnbull IC, Malik R et al (2010) Outcome of elective endovascular abdominal aortic aneurysm repair in octogenarians and nonagenarians. J Vasc Surg 51:1354–1359

    Article  PubMed  Google Scholar 

  16. Prinssen M, Verhoeven EL, Buth J et al (2004) A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 351:1607–1618

    Article  PubMed  CAS  Google Scholar 

  17. Raval MV, Eskandari MK (2012) Outcomes of elective abdominal aortic aneurysm repair among the elderly: endovascular versus open repair. Surgery 151:245–260

    Article  PubMed  Google Scholar 

  18. Schermerhorn ML, Bensley RP, Giles KA et al (2012) Changes in abdominal aortic aneurysm rupture and short-term mortality, 1995–2008: a retrospective observational study. Ann Surg 256:651–658

    Article  PubMed  Google Scholar 

  19. Schermerhorn ML, O’malley AJ, Jhaveri A et al (2008) Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med 358:464–474

    Article  PubMed  CAS  Google Scholar 

  20. Steyerberg EW, Kievit J, De Mol Van Otterloo JC et al (1995) Perioperative mortality of elective abdominal aortic aneurysm surgery. A clinical prediction rule based on literature and individual patient data. Arch Intern Med 155:1998–2004

    Article  PubMed  CAS  Google Scholar 

  21. Umscheid T, Eckstein HH, Noppeney T et al (2001) Qualitätsmanagement Bauchaortenaneurysma der Deutschen Gesellschaft für Gefäßchirurgie (DGG) – Ergebnisse 2000. Gefässchirurgie 6:194–200

    Article  Google Scholar 

  22. Weber H, Eckstein HH, Niedermeier HP et al (2002) Ergebnisqualität in der Gefäßchirurgie. Chirurg 73:559–566

    Article  PubMed  CAS  Google Scholar 

Download references

Compliance with ethic guidelines

Conflict of interest. M. Trenner, B. Haller, H. Söllner, M. Storck, T. Umscheid, H. Niedermeier and H.H. Eckstein declare that they have no conflict of interest.

This article does not contain any studies with human or animal subjects.

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie, Klinikum Rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland

    M. Trenner, H. Söllner &  H.-H. Eckstein

  2. Institut für Medizinische Statistik und Epidemiologie, Technischen Universität München, München, Deutschland

    B. Haller

  3. Städtisches Klinikum Karlsruhe, Klinik für Gefäß- und Thoraxchirurgie, Karlsruhe, Deutschland

    M. Storck

  4. HELIOS Privatklinik Bad Nauheim, Bad Nauheim, Deutschland

    T. Umscheid

  5. Klinik für Gefäßchirurgie, vasculäre und endovasculäre Chirurgie, Städtisches Klinikum München, München, Deutschland

    H. Niedermeier

  6. Kommission für Qualität und Sicherheit, Deutschen Gesellschaft für Gefäßchirurgie und Gefäßmedizin (DGG), Berlin, Deutschland

    M. Storck, T. Umscheid & H. Niedermeier

Authors
  1. M. Trenner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Haller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Söllner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Storck
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. Umscheid
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H. Niedermeier
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. H.-H. Eckstein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H.-H. Eckstein.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Trenner, M., Haller, B., Söllner, H. et al. 12 Jahre „Qualitätssicherung BAA“ der DGG. Gefässchirurgie 18, 206–213 (2013). https://doi.org/10.1007/s00772-013-1159-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00772-013-1159-z

Schlüsselwörter

Keywords

Search

Navigation