title: The impact of endovascular aneurysm repair on mortality for elective abdominal aortic aneurysm repair in England and the United States.
abstract: BACKGROUND
  Procedural mortality is of paramount importance for patients undergoing elective abdominal aortic aneurysm (AAA) repair. Previous comparative studies have demonstrated international differences in the care of ruptured AAA. This study compared the use of endovascular aneurysm repair (EVAR) and in-hospital mortality for elective AAA repair in England and the United States.
  
  
  METHODS
  The English Hospital Episode Statistics and the U.S. Nationwide Inpatient Sample (NIS) were interrogated for elective AAA repair from 2005 to 2010. In-hospital mortality and the use of EVAR were analyzed separately for each health care system, after within-country risk adjustment for age, gender, year, and an accepted national comorbidity index.
  
  
  RESULTS
  The study included 21,272 patients with AAA in England, of whom 86.61% were male, with median (interquartile range) age of 74 (69-79) years. There were 196,113 AAA patients in the United States, of whom 76.14% were male, with median (interquartile range) age of 73 (67-78) years. In-hospital mortality was greater in England (4.09% vs 1.96 %; P < .01) and EVAR less common (37.33% vs 64.36%; P < .01). These observations persisted in age- and gender-matched comparison. In both countries, lower mortality and greater use of EVAR were seen in centers performing greater numbers of AAA repairs per annum. In England, lower mortality and greater use of EVAR were seen in teaching hospitals with larger bed capacity.
  
  
  CONCLUSIONS
  In-hospital survival and the uptake of EVAR are lower in England than in the United States. In both countries, mortality was lowest in high-caseload centers performing a greater proportion of cases with endovascular repair. These common factors suggest strategies for improving outcomes for patients requiring elective AAA repair.
authors.affiliation: Vascular Surgery Department, St George's Vascular Institute, St George's University, London, United Kingdom.
authors.forename: Alan
authors.initials: A
authors.lastname: Karthikesalingam
authors.affiliation: Vascular Surgery Department, St George's Vascular Institute, St George's University, London, United Kingdom.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Holt
authors.affiliation: Population Health Research Institute, St George's University, London, United Kingdom.
authors.forename: Alberto
authors.initials: A
authors.lastname: Vidal-Diez
authors.affiliation: Vascular Surgery Department, St George's Vascular Institute, St George's University, London, United Kingdom. Electronic address: bahia_sandeep@yahoo.co.uk.
authors.forename: Sandeep S
authors.initials: SS
authors.lastname: Bahia
authors.affiliation: Vascular Surgery Department, St George's Vascular Institute, St George's University, London, United Kingdom.
authors.forename: Benjamin O
authors.initials: BO
authors.lastname: Patterson
authors.affiliation: Vascular Surgery Department, St George's Vascular Institute, St George's University, London, United Kingdom.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hinchliffe
authors.affiliation: Vascular Surgery Department, St George's Vascular Institute, St George's University, London, United Kingdom.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Thompson
mesh_terms: D000367:Age Factors; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality* / Q000639:trends; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality* / Q000639:trends; D004739:England; D005260:Female; D006742:Hospital Bed Capacity; D017052:Hospital Mortality / Q000639:trends; D061847:Hospitals, High-Volume; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians' / Q000639:trends; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States