Réparations électives d’anévrismes de l’aorte abdominale sous-rénale en France: comparaison des approches endovasculaires et conventionnelles : analyse de 40 273 séjours issus de la base nationale du PMSI. Bouchet-Badel, M. Ph.D. Thesis, Université de Lille, 2018-...., France, 2019.
abstract   bibtex   
The aim of this work is to provide additional quantitative arguments concerning AAA endografts with comprehensive EVAR data, in order to support political decisions regarding the AAA. Context: Infra-renal abdominal aortic aneurysm (AAA) induces a high mortality rate of more than 80% when ruptured, affecting mainly men, aged over 50 years old, with a peak from 75 to 84 years old. Studies of EVAR have reported improved short-term or postoperative mortality as well as numerous benefits of reduced operative time, avoidance of general anesthesia, reduction of trauma and postoperative pain, reduced length of stay and intensive care, reduced blood loss, and reduced immediate post-operative mortality. And yet, EVAR presents to be associated with an increased late mortality, due to long-term complications. Methods: A population-based, retrospective cohort study using hospital discharges of all patients who underwent a surgical elective AAA repair in France (including all for-profit and nonprofit hospitals) from January 1, 2008 to December 31, 2014 extracted from the PMSI database was exploited. Multivariate logistic regressions were employed and variables tested were: patients’ characteristics and comorbidities, hospital characteristics, and admission characteristics. Results: The study population comprehended 40,273 inpatients. There were 18,096 cases with OPEN (44.9%) and 22,177 cases with EVAR (55.1%). The use of EVAR in non-emergency AAA repair has grown from about 1/3 of AAA surgeries in 2008 (38.8% of the 5,588 AAA repair surgeries) to about 2/3 of AAA surgeries in 2014 (64.2% of the 5,806 AAA repair surgeries). The population undergoing EVAR surgery is mainly made of male patients (92.0%) over 69 years old (mean of 75 years (SD=0.13)) with high burden of multisystem atherosclerosis. EVAR patients stay less longer in-hospital. Risk of 30-day in-hospital death is higher for OPEN patients (OPEN 3.75% versus EVAR 1.31%, p=0). Age, predominantly over 80 years old (OR=5.67), majors risk of seeing a choice of an EVAR approach rather than OPEN. The choice of OPEN (OR=6.87), the high-workload status of the hospital (OR=2.17), being admitted through the ER (OR=2.35) appeared to be factors that major the risk of needing an in-hospital stay in the ICU. The hospital activity of 300 procedures per year or more significantly decreased the probability of occurrence of in-hospital death (OR=0.85). In order to compare EVAR and OPEN surgery, only RCTs can provide with interpretable results, due to the importance of the indication bias.
@phdthesis{bouchet-badel_reparations_2019,
	address = {2018-...., France},
	type = {Thèse d'exercice},
	title = {Réparations électives d’anévrismes de l’aorte abdominale sous-rénale en {France}: comparaison des approches endovasculaires et conventionnelles : analyse de 40 273 séjours issus de la base nationale du {PMSI}},
	shorttitle = {Réparations électives d’anévrismes de l’aorte abdominale sous-rénale en {France}},
	abstract = {The aim of this work is to provide additional quantitative arguments concerning AAA endografts with comprehensive EVAR data, in order to support political decisions regarding the AAA. Context: Infra-renal abdominal aortic aneurysm (AAA) induces a high mortality rate of more than 80\% when ruptured, affecting mainly men, aged over 50 years old, with a peak from 75 to 84 years old. Studies of EVAR have reported improved short-term or postoperative mortality as well as numerous benefits of reduced operative time, avoidance of general anesthesia, reduction of trauma and postoperative pain, reduced length of stay and intensive care, reduced blood loss, and reduced immediate post-operative mortality. And yet, EVAR presents to be associated with an increased late mortality, due to long-term complications. Methods: A population-based, retrospective cohort study using hospital discharges of all patients who underwent a surgical elective AAA repair in France (including all for-profit and nonprofit hospitals) from January 1, 2008 to December 31, 2014 extracted from the PMSI database was exploited. Multivariate logistic regressions were employed and variables tested were: patients’ characteristics and comorbidities, hospital characteristics, and admission characteristics. Results: The study population comprehended 40,273 inpatients. There were 18,096 cases with OPEN (44.9\%) and 22,177 cases with EVAR (55.1\%). The use of EVAR in non-emergency AAA repair has grown from about 1/3 of AAA surgeries in 2008 (38.8\% of the 5,588 AAA repair surgeries) to about 2/3 of AAA surgeries in 2014 (64.2\% of the 5,806 AAA repair surgeries). The population undergoing EVAR surgery is mainly made of male patients (92.0\%) over 69 years old (mean of 75 years (SD=0.13)) with high burden of multisystem atherosclerosis. EVAR patients stay less longer in-hospital. Risk of 30-day in-hospital death is higher for OPEN patients (OPEN 3.75\% versus EVAR 1.31\%, p=0). Age, predominantly over 80 years old (OR=5.67), majors risk of seeing a choice of an EVAR approach rather than OPEN. The choice of OPEN (OR=6.87), the high-workload status of the hospital (OR=2.17), being admitted through the ER (OR=2.35) appeared to be factors that major the risk of needing an in-hospital stay in the ICU. The hospital activity of 300 procedures per year or more significantly decreased the probability of occurrence of in-hospital death (OR=0.85). In order to compare EVAR and OPEN surgery, only RCTs can provide with interpretable results, due to the importance of the indication bias.},
	language = {français},
	school = {Université de Lille},
	author = {Bouchet-Badel, Marie},
	collaborator = {Chazard, Emmanuel},
	year = {2019},
	keywords = {AAA, Anévrisme de l'aorte abdominale -- Chirurgie -- Thèses et écrits académiques, Anévrysme de l'aorte abdominale -- chirurgie -- Dissertation universitaire, EVAR, OPEN, Programme de médicalisation des systèmes d'information -- Thèses et écrits académiques, aortic stent, elective repair, endovascular aneurysm repair, infra-renal abdominal aortic aneurysm, nationwide database, open repair surgery, population-based, retrospective cohort study, vascular endograft, Études de cohortes -- Dissertation universitaire}
}
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