title: Elective open suprarenal aneurysm repair in England from 2000 to 2010 an observational study of hospital episode statistics.
abstract: BACKGROUND
  Open surgery is widely used as a benchmark for the results of fenestrated endovascular repair of complex abdominal aortic aneurysms (AAA). However, the existing evidence stems from single-centre experiences, and may not be reproducible in wider practice. National outcomes provide valuable information regarding the safety of suprarenal aneurysm repair.
  
  
  METHODS
  Demographic and clinical data were extracted from English Hospital Episodes Statistics for patients undergoing elective suprarenal aneurysm repair from 1 April 2000 to 31 March 2010. Thirty-day mortality and five-year survival were analysed by logistic regression and Cox proportional hazards modeling.
  
  
  RESULTS
  793 patients underwent surgery with 14% overall 30-day mortality, which did not improve over the study period. Independent predictors of 30-day mortality included age, renal disease and previous myocardial infarction. 5-year survival was independently reduced by age, renal disease, liver disease, chronic pulmonary disease, and known metastatic solid tumour. There was significant regional variation in both 30-day mortality and 5-year survival after risk-adjustment. Regional differences in outcome were eliminated in a sensitivity analysis for perioperative outcome, conducted by restricting analysis to survivors of the first 30 days after surgery.
  
  
  CONCLUSIONS
  Elective suprarenal aneurysm repair was associated with considerable mortality and significant regional variation across England. These data provide a benchmark to assess the efficacy of complex endovascular repair of supra-renal aneurysms, though cautious interpretation is required due to the lack of information regarding aneurysm morphology. More detailed study is required, ideally through the mandatory submission of data to a national registry of suprarenal aneurysm repair.
authors.affiliation: St George's Vascular Institute, St. George's University of London, London, United Kingdom. alankarthi@gmail.com
authors.forename: Alan
authors.initials: A
authors.lastname: Karthikesalingam
authors.forename: Peter J E
authors.initials: PJ
authors.lastname: Holt
authors.forename: Benjamin O
authors.initials: BO
authors.lastname: Patterson
authors.forename: Alberto
authors.initials: A
authors.lastname: Vidal-Diez
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sollazzo
authors.forename: Jan D
authors.initials: JD
authors.lastname: Poloniecki
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hinchliffe
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Thompson
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures; D004739:England; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012306:Risk; D016896:Treatment Outcome