Trends in Abdominal Aortic Aneurysm Management in France Between 2012 and 2021 From the French Nationwide Database:...

This study aimed to analyze recent trends of surgical management and early outcomes in the treatment of abdominal aortic aneurysm (AAA) from the French national Health Data System (SNDS).

This study was a retrospective multicenter cohort study based on a national medico-economic database. All ruptured (rAAA) or intact AAA (iAAA) treated between 2012 and 2021 related to a primary procedure code for endovascular aneurysm repair (EVAR) or open aortic surgery (OAR) extracted from the SNDS were included. The modified Elixhauser score was used for grading patient's comorbidities. The primary endpoint was to describe the evolution of practices in France regarding the management of AAA and associated inhospital outcomes. Secondary endpoints included identifying predictors of inhospital mortality, assessing center volume, and analyzing overall survival during follow-up.

Overall, 70,088 AAAs were included, comprising 5648 rAAA, 1579 (28%) treated with EVAR and 4069 (72%) with OAR, and 64,440 iAAAs, of which 41,916 (65%) underwent EVAR and 22,524 (35%) OAR. Over the study period, the proportion of EVAR increased significantly, whereas 30-day mortality remained stable, except for rAAA treated with EVAR, where it varied over time. EVAR was associated with lower 30-day mortality compared to OAR for both iAAAs (1.3% vs. 4.1%; p < 0.001) and rAAA (18.7% vs. 35.5%; p < 0.001). For both iAAA and rAAA, significant predictors of inhospital mortality included a higher Elixhauser comorbidity score, and age ≥ 80 years, female sex. Also, OAR was independently associated with higher inhospital mortality (adjusted OR 1.96 for iAAA and 2.22 for rAAA). A graphical association was observed between higher center volume and lower inhospital mortality. The estimated 8-year survival for iAAA was 46% after EVAR and 56% after OAR (log rank p = 0.002).

The proportion of iAAA and rAAA treated with EVAR increased throughout the study period. Increased Elixhauser score, age over 80 years, and female sex are associated with increased postoperative mortality. Higher volume centers have improved postoperative mortality rates.