5-year results on abdominal aortic aneurysm repair in a tertiary center: a benchmark analysis from the Portuguese registry
DOI:
https://doi.org/10.48750/acv.683Keywords:
abdominal aortic aneurysm, registries, mortality, endovascular procedureAbstract
Introduction: Solid registries are crucial to audit results and improve practices on aortic aneurysm (AAA) repair. Accordingly, the Portuguese Society for Vascular Surgery (SPACV) has implemented a national registry since 2019. We aimed to benchmark our results in the registry to identify discrepancies and improve practice.
Methods: We compared data from the SPACV registry from November 2019 to December 2024 on consecutive patients subjected to aortic surgery in our center (cohort A) and nationwide (cohort B). We analyzed demographics, preoperative comorbidities and AAA characteristics (extent, diameter, admission mode). The primary outcome was 30-day mortality. Secondary outcomes included postoperative stroke, cardiac events and renal failure.
Results: 2000 consecutive patients underwent surgery in cohort B, of which 402 were treated in group A (20.1%). Mean age was similar in both cohorts (73.7±8.5 in A vs. 73.9±11.5 in B). Most patients were male (92.8% in A vs. 93.22% in B). 58.2% of aneurysms were infrarenal. Most procedures were elective (79.9% in A vs. 80.9% in B) and predominantly endovascular (75.1% in A vs. 72.95% in B). Preoperative diameter was 63.5±16 mm, significantly larger in urgent cases (74.7±21.81 vs. 60.7±12.8mm). 30-day mortality in cohort A was 8.59%, in line with cohort B and significantly higher in urgent cases (31.25% vs 2.85%). 30-day mortality in both cohorts were similar. Cohort A 30-day rates for stroke, myocardial infarction, and bowel ischemia were 1.52%, 4.80%, and 4.04%, respectively. In cohort A, 30-day mortality significantly correlated with age (per 10-unit increase OR 1.068), urgent setting (OR 1.24) and preoperative creatinine (per-10 unit increase OR 1.001). EVAR conferred a reduced mortality risk (OR 0.88).
Conclusions: Auditing national registries promotes better AAA repair outcomes. Our center's EVAR rates and 30-day mortality align with current national and international practices. Real-world data helps identify mortality predictors and potential improvements for daily practice.
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