12 Jahre "qualitätssicherung BAA" der DGG: Teil 1: Trends in Therapie und Outcome des nicht rupturierten abdominellen Aortenaneurysmas in Deutschland zwischen 1999 und 2010

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.