Trends in Abdominal Aortic and Iliac Aneurysm Repairs in Norway from 2001 to 2013.
OBJECTIVE
The objective was to examine trends in abdominal aortic and iliac aneurysm repairs in Norway from 2001 to 2013, and study regional variations and organizational developments in this type of vascular surgery.


METHODS
This was a retrospective study on aortic and iliac aneurysm repairs using data from the Norwegian Patient Register. The vascular centers were categorized by yearly volume of repairs into small (<18), medium (18-49) and large (≥50). Incidence rates were assessed per 100,000 ≥ 60 years. The percentage of endovascular aneurysm repairs (EVAR) was calculated among the conducted repairs at the three categories of centers and the South-Eastern, Western, Central, and Northern Norway Regional Health Authority (NRHA).


RESULTS
The national incidence rates of intact repairs per 100,000 ≥ 60 years increased from 57.4 to 65.7 (p < .01). Ruptured repairs decreased from 19.7 to 9.2 (p < .01). The rate of EVAR increased from 6.0 to 29.9 (p < .01) in intact and from 0.4 to 2.5 (p < .01) in ruptured repairs. The vascular centers were reduced from 25 to 16. The rate of EVAR was 27.1% (p < .01) higher at large centers and 7.9% (p < .03) higher at medium centers compared with small centers, and from 11.1% to 15.7% higher (p < .01) at the Central, Western, and Northern NRHA compared with the South-Eastern NRHA, which had the most centers (also in the large category). The national increase in intact EVAR from 10.6% to 43.3% was less compared with many other Western countries.


CONCLUSIONS
During the study period the rates of intact repairs increased while the ruptured repairs decreased. EVAR was associated with centers performing high volumes of abdominal aortic and iliac aneurysm repairs and regional authorities organized with few centers.
The Intervention Centre, Oslo University Hospital, Rikshospitalet, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway. Electronic address: kwendt@ous-hf.no.
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Wendt
Department of Informatics, Oslo University Hospital, Rikshospitalet, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway.
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Kristiansen
Department of Cardiothoracic and Vascular Surgery, Oslo University Hospital, Rikshospitalet, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, P.O. Box 1078 Blindern, N-0316 Oslo, Norway.
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Krohg-Sørensen
Oslo Centre for Biostatistics and Epidemiology (OCBE), Oslo University Hospital, Rikshospitalet, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway.
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Gregersen
The Intervention Centre, Oslo University Hospital, Rikshospitalet, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, P.O. Box 1078 Blindern, N-0316 Oslo, Norway.
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Fosse
D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D002497:Centralized Hospital Services / Q000639:trends; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D005260:Female; D061847:Hospitals, High-Volume / Q000639:trends; D061846:Hospitals, Low-Volume / Q000639:trends; D006801:Humans; D017543:Iliac Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
Abdominal aortic aneurysm; Endovascular aneurysm repair; Open repair; Organization and administration; Vascular surgical procedures