The impact of randomized trial results on abdominal aortic aneurysm repair rates from 2003 to 2016: A population-based time-series analysis-Reference-Cited by-同舟云学术

The impact of randomized trial results on abdominal aortic aneurysm repair rates from 2003 to 2016: A population-based time-series analysis

Published:2019-03-24 Issue:4 Volume:27 Page:417-426
ISSN:1708-5381
Container-title:Vascular
language:en
Short-container-title:Vascular

Author:

Salata Konrad¹²^ORCID,Hussain Mohamad A¹²,Mestral Charles de¹²,Greco Elisa¹²,Mamdani Muhammad³⁴⁵⁶⁷,Tu Jack V⁶⁷⁸⁹,Forbes Thomas L¹¹⁰,Bhatt Deepak L¹¹¹²^ORCID,Verma Subodh¹³¹⁴,Al-Omran Mohammed¹²¹⁵

Affiliation:

1. Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada

2. Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada

3. Li Ka Shing Centre for Healthcare Analytics Research and Training (CHART), Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada

4. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada

5. Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

6. Institute of Health Policy, Management and Evaluation, Dalla Lana Faculty of Public Health, University of Toronto, Toronto, ON, Canada

7. Institute for Clinical Evaluative Sciences at Sunnybrook Hospital, Toronto, ON, Canada

8. Division of Cardiology, Department of Medicine, Schulich Heart Program, Sunnybrook Hospital, Toronto, ON, Canada

9. Schulich Heart Research Program, Sunnybrook Research Institute at Sunnybrook Hospital, Toronto, ON, Canada

10. Division of Vascular Surgery, Toronto General Hospital, Toronto, ON, Canada

11. Brigham and Women's Hospital Heart and Vascular Center, Boston, MA, USA

12. Harvard Medical School, Boston, MA, USA

13. Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada

14. Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada

15. Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia

Abstract

Objectives The uptake of endovascular aortic repair for elective and ruptured abdominal aortic aneurysm repair is not well studied. We aimed to examine the trends in open surgical repair and endovascular aortic repair of eAAA and rAAA and to examine the effects of randomized trial publications on elective open surgical repair and endovascular aortic repair rates. Methods We conducted a population-based time-series analysis of eAAA and rAAA repairs in Ontario, Canada from 2003 to 2016. We examined changes in overall and approach-specific rates of eAAA and rAAA repair using exponential smoothing models. Interventional autoregressive integrated moving average models were fit to the eAAA rates to examine the impact of randomized trial results on these rates. Results We identified 19,489 eAAA (12,232 open (63%) and 7257 endovascular (37%)) and 2732 rAAA (2466 open (90%) and 266 endovascular (10%)) repairs from 2003 to 2016. The rate of eAAA repair declined from 6.39/100,000 in 2003 to 5.59/100,000 in 2016 (13% decrease, p = 0.17). The rate of elective open surgical repair decreased nearly three-fold from 6.07/100,000 to 2.12/100,000 ( p < 0.0001), while elective endovascular aortic repair increased approximately 10-fold (0.32/100,000 to 3.47/100,000, p < 0.0001). The rate of ruptured open surgical repair decreased from 1.62/100,000 to 0.37/100,000 ( p < 0.44), while ruptured endovascular aortic repair uptake increased (0.00/100,000 to 0.12/100,000, p < 0.25). The mid-term results of the DREAM and EVAR-1 trials were associated with a decrease in the rate of elective open surgical repair decline after 2010 ( p = 0.01). Conclusions While elective open surgical repair use has significantly decreased from 2003 to 2016, elective endovascular aortic repair use has significantly increased. The DREAM and EVAR-1 results significantly impacted the observed rates of elective open surgical repair only. The reasons for these trends require further characterization.

Funder

Physicians' Services Incorporated Foundation

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,Radiology Nuclear Medicine and imaging,General Medicine,Surgery

Link

http://journals.sagepub.com/doi/pdf/10.1177/1708538119829582

Reference56 articles.

1. Transfemoral Intraluminal Graft Implantation for Abdominal Aortic Aneurysms

2. 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

3. A Randomized Trial Comparing Conventional and Endovascular Repair of Abdominal Aortic Aneurysms

4. Outcomes Following Endovascular vs Open Repair of Abdominal Aortic AneurysmA Randomized Trial

5. Long-Term Outcome of Open or Endovascular Repair of Abdominal Aortic Aneurysm

Cited by 3 articles. 订阅此论文施引文献订阅此论文施引文献，注册后可以免费订阅5篇论文的施引文献，订阅后可以查看论文全部施引文献

1. Outcomes of abdominal aortic aneurysm repair among patients with rheumatoid arthritis;Journal of Vascular Surgery;2021-04

2. Population-based long-term outcomes of open versus endovascular aortic repair of ruptured abdominal aortic aneurysms;Journal of Vascular Surgery;2020-06

3. Impact of surgical intervention trials on healthcare: A systematic review of assessment methods, healthcare outcomes, and determinants;PLOS ONE;2020-05-22