Two decades of abdominal aortic aneurysm repair: Have we made any progress?

Purpose: Over the past 20 years, there have been numerous advances in our a bility to detect and to treat abdominal aortic aneurysms (AAAs). We hypothe sized that these advances would lead to (1) an increase in the rate of elec tive repair and a decrease in the incidence of ruptured AAA (rAAA) and (2) a decrease in operative deaths for both elective AAA (eAAA) and rAAA. Methods: To test these hypotheses, we investigated the incidence and outcom es of eAAA and 1 AAA. surgery between 1979 and 1997, using the National Hos pital Discharge Survey. This data set is a randomized, stratified sample re presenting discharges from the nation's acute care, nonfederally funded hos pitals. Codes from the International Classification of Diseases, Ninth Revi sion were used to identify our study population. Results: Over the past 19 years, there has been no change in the incidence rate of eAAA repair (range , 44.1-77.9 per 100,000). Moreover, the incidence of rAAAs presenting to th e nation's hospitals has not changed (range, 6.6-16.3 per 100,000). There h as been no consistent improvement over time in operative deaths associated with either eAAA or rAAA repair (average rates over the study period: eAAA, 5.6%; rAAA, 45.7%). Significant predictors of death from eAAA in patients included an age older than 80 years, African American race, congestive hear t failure (CHF), and diabetes (P < .0001 for all). Significant predictors o f death from rAAA in patients included age older than 70 years, African Ame rican race, female sex, renal failure, and a hospital bed size more than 50 0 (P < .05 for all). Conclusion: On a national level, over the past 19 years, our ability to ide ntify and to treat patients with AAA has not improved. Advances in technolo gy and critical care have not affected outcome. Regionalization of care, sc reening of high-risk populations, and endovascular repair are strategies th at might allow further improvement in the outcome of patients with aneurysm al disease.