Incidence, Treatment and Mortality in Patients with Abdominal Aortic Aneurysms

Abstract

Background: Aim of this study was to analyze hospital incidence, type of treatment, and hospital mortality rates of patients with abdominal aortic aneurysm (AAA) in Germany from 2005 to 2014.

Methods: Microdata of the diagnosis-related group (DRG) statistics compiled by the German Federal Statistical Office for the years 2005-2014 were analyzed. Patients who were hospitalized for a ruptured AAA (rAAA, ICD-10 code I71.3, treated either surgically or conservatively) or received surgical treatment for an unruptured AAA (nrAAA, ICD-10-Code I71.4, treated either with open surgery or an endovascular procedure) were included in the analysis. The "European Standard Population 2013" was used for direct standardization of the hospital incidences. In-hospital mortality was calculated with standardization for age and risk.

Results: The standardized overall hospital incidence of AAA was 27.9 and 3.3 cases per 100 000 people for men and women, respectively; over the period of the study, the incidence of rAAA fell by 30% in both sexes and that of nrAAA rose by 16% in men and 42% in women. The percentage of patients receiving endovascular treatment rose from 29% to 75% in patients with nrAAA and from 8% to 36% in patients with rAAA. The age- and risk-standardized in-hospital mortality of nrAAA was 3.3% in men and 5.3% in women. The in-hospital mortality of surgically treated rAAA was 39% in men and 48% in women.

Conclusion: The hospital incidence of AAA rose from 2005 to 2014, while that of rAAA fell. Endovascular treatment became more common for nrAAA as well as rAAA, and in-hospital mortality fell for both.

Figures

Figure 1

Age-standardized hospital incidence from 2005–2014 * direct age standardization AAA, abdominal aortic aneurysm; nrAAA, non-ruptured AAA; OP, operatively treated (with open surgery or endovascularly); rAAA, ruptured AAA

Figure 2

Mortality (age- and risk-adjusted) for the period from 2005 to 2014 (for raw values, see eFigure 6) * The Elixhauser Index was used for risk adjustment (40). AAA, abdominal aortic aneurysm; nrAAA, non-ruptured AAA; OP, operatively treated (with open surgery or endovascularly); rAAA, ruptured AAA

eFigure 1

Patient flow diagram * operative treatment of aneurysm by open surgery, endovascular aortic repair, or combination surgery. The characteristics of the excluded subgroups can be found in eTable 2. AAA, abdominal aortic aneurysm; DRG, diagnosis-related groups; nrAAA, non-ruptured AAA; ICD, International Classification of Diseases; PD, principal diagnosis; rAAA, ruptured AAA; SD, secondary diagnosis

eFigure 2

Age-standardized hospital incidence for all included AAA (left) and all included rAAA (right) from 2005–2014 * directly age-standardized AAA, abdominal aortic aneurysm; rAAA. ruptured AAA

eFigure 3

Time period 2005–2014 for the median case-mix index (top) and the median Elixhauser Comorbidity Index (bottom) for treated nrAAA (left) and rAAA (right) AAA, abdominal aortic aneurysm; nrAAA, non-ruptured AAA; OP, operatively treated (with open surgery or endovascularly); rAAA, ruptured AAA

eFigure 4

Proportion of endovascularly-treated patients presenting with nrAAA (left) or rAAA (right) during 2005–2014 AAA, abdominal aortic aneurysm; EVAR, endovascular aneurysm repair; nrAAA, non-ruptured AAA; OP, operatively treated (with open surgery or endovascularly); rAAA, ruptured AAA

eFigure 5

Median length of stay for patients treated for nrAAA (left) or rAAA (right) during 2005–2014 AAA, abdominal aortic aneurysm; nrAAA, non-ruptured AAA; OP, operatively treated (with open surgery or endovascularly); rAAA, ruptured AAA

eFigure 6

Raw values for in-hospital mortality AAA, abdominal aortic aneurysm; nrAAA, non-ruptured AAA; OP, operatively treated (with open surgery or endovascularly); rAAA, ruptured AAA

eFigure 7

Mortality (age- and risk-adjusted) for all included AAA (left) as well as for all included rAAA (right) from 2005–2014 (for raw values, see eFigure 6). *The Elixhauser Index was used for risk adjustment (40). AAA, abdominal aortic aneurysm; rAAA. ruptured AAA