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Nationwide Analysis of Ruptured Abdominal Aortic Aneurysm in Portugal (2000-2015).
Eur J Vasc Endovasc Surg. 2020 Jul; 60(1):27-35.EJ

Abstract

OBJECTIVE

Ruptured abdominal aortic aneurysm (rAAA) is a lethal condition that requires acute repair to prevent death. This analysis aims to assess the nationwide trends in rAAA admission, repair and mortality in a country, Portugal, without national screening for AAA.

METHODS

rAAA registered in the hospital administrative database of the National Health Service and all nationally registered deaths due to rAAA based on death certificate data were analysed. Three time periods (2000-2004, 2005-2009, and 2010-2015) were compared in patients ≥ 50 years old to assess the variations over time.

RESULTS

A total of 2 275 patients ≥50 years old with rAAA were identified in the two databases from 2000 to 2015. The age standardised incidence of rAAA was 2.78 ± 0.24/100 000/year in 2000-2004, 3.17 ± 0.39/100 000/year in 2005-2009 and 3.21 ± 0.28/100 000/year in 2010-2015 (p < .001). When comparing the time periods 2000-2004 to 2005-2009, the age standardised rate of admission (n = 1460) increased from 1.57 ± 0.25/100 000/year to 2.24 ± 0.32/100 000/year (p < .001). The operative mortality rates decreased during this time period (from 55.3 ± 4.7% to 48.8 ± 4.7%, p < .001). In 2010-2015, the age standardised rate of admissions due to rAAA decreased (1.98 ± 0.22/100 000/year). Operative mortality remained stable (48.9 ± 6.2%). The rate of patient deaths outside the hospital decreased from the first to the second period (1.21 ± 0.10/100 000/year and 0.93 ± 0.29/100 000/year, respectively) but later increased (1.14 ± 0.22/100 000/year). This resulted in a higher overall rAAA related mortality in Portugal in the third period (2.20 ± 0.18/100 000/year, 2.21 ± 0.27/100 000/year and 2.26 ± 0.26/100 000/year in 2000-2004, 2005-2009, and 2010-2015, respectively, p < .001).

CONCLUSION

Overall, the incidence of rAAA in Portugal has been stable over the past 10 years. The rates of admission, repair, and death due to rAAA repair seem to have reached an inflection point and are now decreasing. Mortality outside the hospital remains a matter of concern, warranting further planning of streamlined transfer networks and vascular surgical departments.

Authors+Show Affiliations

Department of Angiology and Vascular Surgery, São João Hospital University Centre, Porto, Portugal; Department of Surgery and Physiology, Cardiovascular Research Unit, Faculty of Medicine, University of Porto, Portugal. Electronic address: marina_f_neto@hotmail.com.Department of Angiology and Vascular Surgery, São João Hospital University Centre, Porto, Portugal; Department of Surgery and Physiology, Cardiovascular Research Unit, Faculty of Medicine, University of Porto, Portugal.Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Sweden.Centre for Health Technology and Services Research (CINTESIS) and Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Portugal.Department of Surgery and Physiology, Cardiovascular Research Unit, Faculty of Medicine, University of Porto, Portugal.Centre for Health Technology and Services Research (CINTESIS) and Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Portugal.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32307303

Citation

Dias-Neto, Marina, et al. "Nationwide Analysis of Ruptured Abdominal Aortic Aneurysm in Portugal (2000-2015)." European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, vol. 60, no. 1, 2020, pp. 27-35.
Dias-Neto M, Castro-Ferreira R, Mani K, et al. Nationwide Analysis of Ruptured Abdominal Aortic Aneurysm in Portugal (2000-2015). Eur J Vasc Endovasc Surg. 2020;60(1):27-35.
Dias-Neto, M., Castro-Ferreira, R., Mani, K., Freitas, A., Leite-Moreira, A., & Sampaio, S. M. (2020). Nationwide Analysis of Ruptured Abdominal Aortic Aneurysm in Portugal (2000-2015). European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, 60(1), 27-35. https://doi.org/10.1016/j.ejvs.2020.02.024
Dias-Neto M, et al. Nationwide Analysis of Ruptured Abdominal Aortic Aneurysm in Portugal (2000-2015). Eur J Vasc Endovasc Surg. 2020;60(1):27-35. PubMed PMID: 32307303.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nationwide Analysis of Ruptured Abdominal Aortic Aneurysm in Portugal (2000-2015). AU - Dias-Neto,Marina, AU - Castro-Ferreira,Ricardo, AU - Mani,Kevin, AU - Freitas,Alberto, AU - Leite-Moreira,Adelino, AU - Sampaio,Sérgio Moreira, Y1 - 2020/04/16/ PY - 2019/09/30/received PY - 2020/02/05/revised PY - 2020/02/28/accepted PY - 2020/4/21/pubmed PY - 2020/7/24/medline PY - 2020/4/21/entrez KW - Abdominal aortic aneurysm KW - Epidemiology KW - Incidence KW - Mortality KW - Ruptured aneurysm SP - 27 EP - 35 JF - European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery JO - Eur J Vasc Endovasc Surg VL - 60 IS - 1 N2 - OBJECTIVE: Ruptured abdominal aortic aneurysm (rAAA) is a lethal condition that requires acute repair to prevent death. This analysis aims to assess the nationwide trends in rAAA admission, repair and mortality in a country, Portugal, without national screening for AAA. METHODS: rAAA registered in the hospital administrative database of the National Health Service and all nationally registered deaths due to rAAA based on death certificate data were analysed. Three time periods (2000-2004, 2005-2009, and 2010-2015) were compared in patients ≥ 50 years old to assess the variations over time. RESULTS: A total of 2 275 patients ≥50 years old with rAAA were identified in the two databases from 2000 to 2015. The age standardised incidence of rAAA was 2.78 ± 0.24/100 000/year in 2000-2004, 3.17 ± 0.39/100 000/year in 2005-2009 and 3.21 ± 0.28/100 000/year in 2010-2015 (p < .001). When comparing the time periods 2000-2004 to 2005-2009, the age standardised rate of admission (n = 1460) increased from 1.57 ± 0.25/100 000/year to 2.24 ± 0.32/100 000/year (p < .001). The operative mortality rates decreased during this time period (from 55.3 ± 4.7% to 48.8 ± 4.7%, p < .001). In 2010-2015, the age standardised rate of admissions due to rAAA decreased (1.98 ± 0.22/100 000/year). Operative mortality remained stable (48.9 ± 6.2%). The rate of patient deaths outside the hospital decreased from the first to the second period (1.21 ± 0.10/100 000/year and 0.93 ± 0.29/100 000/year, respectively) but later increased (1.14 ± 0.22/100 000/year). This resulted in a higher overall rAAA related mortality in Portugal in the third period (2.20 ± 0.18/100 000/year, 2.21 ± 0.27/100 000/year and 2.26 ± 0.26/100 000/year in 2000-2004, 2005-2009, and 2010-2015, respectively, p < .001). CONCLUSION: Overall, the incidence of rAAA in Portugal has been stable over the past 10 years. The rates of admission, repair, and death due to rAAA repair seem to have reached an inflection point and are now decreasing. Mortality outside the hospital remains a matter of concern, warranting further planning of streamlined transfer networks and vascular surgical departments. SN - 1532-2165 UR - https://www.unboundmedicine.com/medline/citation/32307303/Nationwide_Analysis_of_Ruptured_Abdominal_Aortic_Aneurysm_in_Portugal_(2000-2015) L2 - https://linkinghub.elsevier.com/retrieve/pii/S1078-5884(20)30159-3 DB - PRIME DP - Unbound Medicine ER -