12 Jahre Qualitätssicherung zum rupturierten und nicht rupturierten abdominalen Aortenaneurysma der Deutschen Gesellschaft für Gefäßchirurgie und Gefäßmedizin (DGG): Teil 3: Prädiktoren für das perioperative Ergebnis unter besonderer Berücksichtigung der Fallzahl/Jahr

Conclusions: Comorbidities (ASA score) and increasing age are significant predictors for increased in-hospital mortality in nrAAA and rAAA. Higher annual volume is associated with lower in-hospital mortality in nrAAA. For both, elective and emergency AAA treatment, a referral to a hospital with high annual AAA caseload should be considered.

Patients and methods: Between 1999 and 2010 a total of 36,594 operations for nrAAA and 4.859 operations for rAAA were recorded in 201 hospitals. Categorical and quantitative characteristics are summarized in descriptive statistics. For the analysis of a relationship between annual hospital caseload and in-hospital mortality, the hospitals were divided into volume groups. A mixed logistic regression model was used for comparing the groups. Additionally an univariate model with volume groups as an influencing variable was adjusted to the data, as well as multivariate models with volume groups, type of surgery, age, AAA size, ASA score and presence of an additional iliac aneurysm or inflammatory AAA as independent variables.

Objective: The aim was to analyze clinical, morphological and structural predictors for the outcome of open and endovascular surgery on non-ruptured (nr) and ruptured (r) abdominal aortic aneurysms (AAA) in the quality assurance registry Abdominal Aortic Aneurysm of the German Vascular Society (Deutschen Gesellschaft für Gefäßchirurgie und Gefäßmedizin, DGG). A main focus was on relationships between annual hospital volume and outcome.

Results: The mean age was 71.0 years (± 8.1) in nrAAA and 73.8 years (± 9.1) in rAAA. In all, 66.7 % of the patients with nrAAA and 88.3 % in rAAA presented with ASA ≥ 3. In nrAAA 37 % of the patients received endovascular aortic repair (EVAR), 11.8 % for rAAA. In-hospital mortality for nrAAA was 2.7 % (open repair (OR) 3.6 %, EVAR 1.3 %), for rAAA 39 % (OR 41.2 %, EVAR 21.8 %).

Univariate analysis showed increasing age, ASA ≥ 3, increasing aneurysm size, inflammatory AAA and OR to be significant predictors for a higher in-hospital mortality in both nrAAA, and rAAA. A significant survival benefit for treatment of nrAAA could be shown for patients treated in hospitals with a caseload of ≥ 31 operations per year (compared to 1–20 operations/year). In rAAA the mortality also showed a decreasing trend in hospitals with higher annual caseloads. Multivariate analysis showed increasing age, AAA diameter ≥ 6 cm, ASA ≥ 3 and OR to be independent predictors for perioperative fatality in nrAAA and rAAA. In nrAAA an annual AAA-volume of 50–62 cases was an independent predictor for lower in-hospital mortality.