title: Hospitalization rates and post-operative mortality for abdominal aortic aneurysm in Italy over the period 2000-2011.
abstract: BACKGROUND
  Recent studies have reported declines in incidence, prevalence and mortality for abdominal aortic aneurysms (AAAs) in various countries, but evidence from Mediterranean countries is lacking. The aim of this study is to examine the trend of hospitalization and post-operative mortality rates for AAAs in Italy during the period 2000-2011, taking into account the introduction of endovascular aneurysm repair (EVAR) in 1990s.
  
  
  METHODS
  This retrospective cohort study was carried out in Emilia-Romagna, an Italian region with 4.5 million inhabitants. A total of 19,673 patients hospitalized for AAAs between 2000 and 2011, were identified from the hospital discharge records (HDR) database. Hospitalization rates, percentage of OSR and EVAR and 30-day mortality rates were calculated for unruptured (uAAAs) and ruptured AAAs (rAAAs).
  
  
  RESULTS
  Adjusted hospitalization rates decreased on average by 2.9% per year for uAAAs and 3.2% for rAAAs (p<0.001). The temporal trend of 30-day mortality rates remained stable for both groups. The percentage of EVAR for uAAAs increased significantly from 2006 to 2011 (42.7 versus 60.9% respectively, mean change of 3.9% per year, p<0.001). No significant difference in mortality was found between OSR and EVAR for uAAAs and rAAAs.
  
  
  CONCLUSIONS
  The incidence and trend of hospitalization rates for rAAAs and uAAAs decreased significantly in the last decade, while 30-day mortality rates in operated patients remained stable. OSR continued to be the most common surgery in rAAAs, although the gap between OSR and EVAR recently declined. The EVAR technique became the preferred surgery for uAAAs since 2008.
authors.affiliation: Department of Surgery, Vascular Surgery Unit, Maggiore Hospital, Bologna, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Sensi
authors.affiliation: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Tedesco
authors.affiliation: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Mimmi
authors.affiliation: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Rucci
authors.affiliation: Department of Surgery, Vascular Surgery Unit, Maggiore Hospital, Bologna, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Pisano
authors.affiliation: Department of Surgery, Vascular Surgery Unit, Maggiore Hospital, Bologna, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Pedrini
authors.affiliation: Stanford Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University, Stanford, California, United States of America.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: McDonald
authors.affiliation: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Fantini
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000401:mortality* / Q000601:surgery* / Q000628:therapy; D001019:Aortic Rupture / Q000150:complications; D057510:Endovascular Procedures / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012306:Risk; D016896:Treatment Outcome