麻豆传媒

Abdominal aortic aneurysm (AAA) repairs were twice as common in the U.S. compared with England, a study found, while American patients were less likely to die or be hospitalized because of an aneurysm than their English peers.

Over the period from 2005 to 2012, open or endovascular repair of intact AAAs was (OR 0.49, 95% CI 0.48-0.49), , of St. George's University of London, and colleagues reported online in the .

Meanwhile, aneurysm-related death (OR 3.60, 95% CI 3.55-3.64) and hospitalization due to an aneurysm rupture were more frequent among the English (OR 2.23, 95% CI 2.19-2.27).

"Among patients who were selected for aneurysm repair, in-hospital mortality and the rates of 3-year survival were similar in England and the United States," the authors wrote. "This finding suggests that the increased rate of aneurysm repair in the United States did not come at the expense of greater perioperative or postoperative risk."

"However, two observations from our data suggest that the lower rate of aneurysm repair in England may have adverse consequences. Although the rate of hospitalization due to aneurysm rupture decreased in both countries over the 8 years studied, this rate was more than twice as high in England as in the United States. In addition, although aneurysm-related mortality also decreased over time in both countries, this rate was 3.5 times as high in England as in the United States."

The data "raise the question of whether outcomes in England would be improved if the repair thresholds used in the United States were adopted," they suggested.

Karthikesalingam's group also found that by the time English patients did receive AAA repair, their aneurysms were likely to be larger in diameter (63.7 mm versus 58.3 mm for Americans, P<0.001).

The study included patients who underwent AAA repair in England (n=29,300) and the U.S. (n=278,921). Karthikesalingam and colleagues retrieved data from multiple national registries from both countries.

England trailed the U.S. for the proportion of endovascular procedures among all AAA repairs. These procedures started to gain traction throughout the study period, although by 2012, endovascular AAA repairs were still less common there in the U.K. (67.2% versus 75.4% for the U.S., P<0.001).

"The rates of aneurysm repair and of aneurysm-related death were derived from separate data sets in both countries, and we have not shown a causal association between the two," the authors warned.

Comment