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Outcomes in Men From the NHS Abdominal Aortic Aneurysm Screening Programme With a Large Aneurysm Referred for
Lewis Meecham1, Jo Jacomelli2, Meryl Davis3
1University Department of Vascular Surgery, Heart of England NHS Foundation Trust, UK.
Objective:
The NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP) has been implemented since 2013. Men with a large aneurysm >54 mm, either at first screen or during surveillance, are referred for intervention. The aim of the present study was to explore outcomes in these men and to see whether there was any regional variation in treatment rates and type of repair.
Methods:
The study cohort included all men referred to a vascular network with a large abdominal aortic aneurysm (AAA). Basic demographic information, nurse assessment details, as well as outcome data were extracted from the national NAAASP IT system, AAA SMaRT, for analysis.
Results:
Some 3 026 men were referred for possible intervention (48% first screen, 52% surveillance). Some 448 men (13.3%) either declined (63, 2.1%), or were turned down for early intervention for various reasons (385, 12.7%). Some 8% were declined for medical reasons (true turn down rate). Men referred from surveillance were older, and more likely not to have had elective surgery within three months (16.0 vs. 11.2%; HR 1.37, 95% CI 1.07-1.75, p = .011). Turn down rates did not vary among local programmes, when surveillance men were taken into account. Some 2 624 (87%) men had planned AAA repair, with a peri-operative mortality of 1.3%. Thirty day surgical mortality was lower after EVAR: 0.4% compared with 2.1% after open repair. The method of repair remained consistent year on year, with roughly equal numbers undergoing endovascular (50%) and open surgical repair (48%); 2% unknown. There was regional variation in the proportion treated by endovascular repair: from 20% to 97%.
Conclusion:
The turn down rate after referral for treatment with a screen detected AAA was low, but there remains considerable regional variation in the proportion undergoing endovascular repair. Procedures were undertaken with low peri-operative mortality.
Insights
Men referred for large abdominal aortic aneurysms had low turn-down rates but varied endovascular repair rates regionally. Procedures showed low peri-operative mortality, with EVAR having lower 30-day surgical mortality than open repair.
Area of Science:
- Vascular Surgery
- Public Health Screening
- Health Services Research
Background:
- The NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP) screens men aged 65+ for large abdominal aortic aneurysms (AAAs) >54 mm.
- Referral for intervention is indicated for men with large AAAs detected during screening or surveillance.
Purpose of the Study:
- To analyze outcomes for men referred for intervention due to large AAAs.
- To investigate regional variations in AAA treatment rates and repair methods.
Main Methods:
- Analysis of data from the national NAAASP IT system (AAA SMaRT).
- Inclusion of all men referred to a vascular network with large AAAs.
- Extraction of demographic, assessment, and outcome data.
Main Results:
- 3,026 men were referred; 13.3% declined or were turned down for intervention.
- Turn-down rates were consistent across local programs.
- 2,624 men underwent AAA repair with 1.3% peri-operative mortality.
- Endovascular Aneurysm Repair (EVAR) had lower 30-day mortality (0.4%) than open repair (2.1%).
- Significant regional variation (20%-97%) in EVAR proportion.
Conclusions:
- Referral turn-down rates for screen-detected AAAs are low.
- Substantial regional disparities exist in endovascular repair rates.
- AAA repair procedures demonstrate low peri-operative mortality.
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