Trends in Hospital Admissions, Operative Approaches, and Mortality Related to Abdominal Aortic Aneurysms in England Between 1998 and 2020

Lydia Hanna; Kim Borsky; Ammar A Abdullah; Viknesh Sounderajah; Dominic C Marshall; Justin D Salciccioli; Joseph Shalhoub; Richard G J Gibbs

doi:10.1016/j.ejvs.2023.03.015

Trends in Hospital Admissions, Operative Approaches, and Mortality Related to Abdominal Aortic Aneurysms in England Between 1998 and 2020

Eur J Vasc Endovasc Surg. 2023 Jul;66(1):68-76. doi: 10.1016/j.ejvs.2023.03.015. Epub 2023 Mar 17.

Authors

Lydia Hanna¹, Kim Borsky², Ammar A Abdullah³, Viknesh Sounderajah⁴, Dominic C Marshall⁵, Justin D Salciccioli⁶, Joseph Shalhoub⁷, Richard G J Gibbs³

Affiliations

¹ Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK. Electronic address: l.hanna@imperial.ac.uk.
² Medical Data Research Collaborative, London, UK; Department of Plastic Surgery, Salisbury NHS Foundation Trust, Salisbury, UK.
³ Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK.
⁴ Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK; Institute of Global Health Innovation, Imperial College London, London, UK.
⁵ Medical Data Research Collaborative, London, UK; Department of Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
⁶ Medical Data Research Collaborative, London, UK; Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁷ Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK; Medical Data Research Collaborative, London, UK.

PMID: 36934837
DOI: 10.1016/j.ejvs.2023.03.015

Abstract

Objective: To assess trends in abdominal aortic aneurysm (AAA) hospital admissions, interventions, and aneurysm related mortality in England, and to examine the impact of endovascular repair on mortality for the years 1998 - 2020.

Methods: Hospital admission and operative approach (endovascular aortic aneurysm repair, or open surgical repair [OSR]) using Hospital Episodes Statistics (HES), and aneurysm related mortality data from the Office for National Statistics for England standardised to the 2013 European Standard Population, were analysed using linear regression and Joinpoint regression analyses. Aneurysm related mortality was compared between the pre-endovascular era (1998 - 2010) and the endovascular era (2011 - 2019).

Results: A declining trend in hospital admission incidence was observed, mainly due to a decline in ruptured admissions from 34.6 per 100 000 (95% confidence interval [CI] 33.5 - 35.6) to 13.5 per 100 000 (95% CI 12.9 - 14.2; β_i = -1.04, r² = .97, p < .001). Operative interventions have been declining over the last 23 years mainly due to the statistically significant decline in open procedures (41.2 per 100 000 in 2000 [95% CI 40 - 42.3] to 9.6 per 100 000 [95% CI 9.1 - 10.1]; β_i = -1.92, r² = .95; p < .001). There was an increasing trend toward endovascular procedures (5.8 per 100 000 [95% CI 5.3 - 6.2] in 2006 to 16.9 per 100 000 [95% CI 16.2 - 17.5] in 2020; β_i = .82, r² = .30, p = .040). Reductions in aneurysm related mortality due to AAAs were observed for males and females, irrespective of age and rupture status.

Conclusion: A significant decrease in hospital admissions for AAAs was observed over the last 23 years in England, paralleled by a shift toward endovascular repair and a decline in OSR. Declines in aneurysm related mortality were observed overall, and in the endovascular era irrespective of age, sex, and rupture status.

Keywords: Abdominal aortic aneurysm; EVAR; Endovascular aortic repair; Epidemiology; Hospital Episode Statistics; Mortality; OSR; Open surgery.

MeSH terms

Aortic Aneurysm, Abdominal* / surgery
Aortic Rupture* / surgery
Blood Vessel Prosthesis Implantation* / adverse effects
Endovascular Procedures* / methods
England / epidemiology
Female
Hospitals
Humans
Male
Retrospective Studies
Risk Factors
Treatment Outcome