title: Thresholds for Abdominal Aortic Aneurysm Repair in England and the United States.
abstract: Thresholds for repair of abdominal aortic aneurysms vary considerably among countries.
  
  
  
  We examined differences between England and the United States in the frequency of aneurysm repair, the mean aneurysm diameter at the time of the procedure, and rates of aneurysm rupture and aneurysm-related death. Data on the frequency of repair of intact (nonruptured) abdominal aortic aneurysms, in-hospital mortality among patients who had undergone aneurysm repair, and rates of aneurysm rupture during the period from 2005 through 2012 were extracted from the Hospital Episode Statistics database in England and the U.S. Nationwide Inpatient Sample. Data on the aneurysm diameter at the time of repair were extracted from the U.K. National Vascular Registry (2014 data) and from the U.S. National Surgical Quality Improvement Program (2013 data). Aneurysm-related mortality during the period from 2005 through 2012 was determined from data obtained from the Centers for Disease Control and Prevention and the U.K. Office of National Statistics. Data were adjusted with the use of direct standardization or conditional logistic regression for differences between England and the United States with respect to population age and sex.
  
  
  
  During the period from 2005 through 2012, a total of 29,300 patients in England and 278,921 patients in the United States underwent repair of intact abdominal aortic aneurysms. Aneurysm repair was less common in England than in the United States (odds ratio, 0.49; 95% confidence interval [CI], 0.48 to 0.49; P<0.001), and aneurysm-related death was more common in England than in the United States (odds ratio, 3.60; 95% CI, 3.55 to 3.64; P<0.001). Hospitalization due to an aneurysm rupture occurred more frequently in England than in the United States (odds ratio, 2.23; 95% CI, 2.19 to 2.27; P<0.001), and the mean aneurysm diameter at the time of repair was larger in England (63.7 mm vs. 58.3 mm, P<0.001).
  
  
  
  We found a lower rate of repair of abdominal aortic aneurysms and a larger mean aneurysm diameter at the time of repair in England than in the United States and lower rates of aneurysm rupture and aneurysm-related death in the United States than in England. (Funded by the Circulation Foundation and others.).
authors.affiliation: From St. George's Vascular Institute, St. George's University of London, London (A.K., A.V.-D., P.J.H., I.M.L., M.M.T.); and the Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School (M.L.S., P.A.S.), and the Department of Health Care Policy, Harvard Medical School (B.E.L.) - both in Boston.
authors.forename: Alan
authors.initials: A
authors.lastname: Karthikesalingam
authors.affiliation: From St. George's Vascular Institute, St. George's University of London, London (A.K., A.V.-D., P.J.H., I.M.L., M.M.T.); and the Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School (M.L.S., P.A.S.), and the Department of Health Care Policy, Harvard Medical School (B.E.L.) - both in Boston.
authors.forename: Alberto
authors.initials: A
authors.lastname: Vidal-Diez
authors.affiliation: From St. George's Vascular Institute, St. George's University of London, London (A.K., A.V.-D., P.J.H., I.M.L., M.M.T.); and the Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School (M.L.S., P.A.S.), and the Department of Health Care Policy, Harvard Medical School (B.E.L.) - both in Boston.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Holt
authors.affiliation: From St. George's Vascular Institute, St. George's University of London, London (A.K., A.V.-D., P.J.H., I.M.L., M.M.T.); and the Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School (M.L.S., P.A.S.), and the Department of Health Care Policy, Harvard Medical School (B.E.L.) - both in Boston.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Loftus
authors.affiliation: From St. George's Vascular Institute, St. George's University of London, London (A.K., A.V.-D., P.J.H., I.M.L., M.M.T.); and the Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School (M.L.S., P.A.S.), and the Department of Health Care Policy, Harvard Medical School (B.E.L.) - both in Boston.
authors.forename: Marc L
authors.initials: ML
authors.lastname: Schermerhorn
authors.affiliation: From St. George's Vascular Institute, St. George's University of London, London (A.K., A.V.-D., P.J.H., I.M.L., M.M.T.); and the Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School (M.L.S., P.A.S.), and the Department of Health Care Policy, Harvard Medical School (B.E.L.) - both in Boston.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Soden
authors.affiliation: From St. George's Vascular Institute, St. George's University of London, London (A.K., A.V.-D., P.J.H., I.M.L., M.M.T.); and the Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School (M.L.S., P.A.S.), and the Department of Health Care Policy, Harvard Medical School (B.E.L.) - both in Boston.
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Landon
authors.affiliation: From St. George's Vascular Institute, St. George's University of London, London (A.K., A.V.-D., P.J.H., I.M.L., M.M.T.); and the Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School (M.L.S., P.A.S.), and the Department of Health Care Policy, Harvard Medical School (B.E.L.) - both in Boston.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Thompson
mesh_terms: D001012:Aorta, Abdominal / Q000473:pathology*; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001019:Aortic Rupture / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D012307:Risk Factors; D014481:United States / Q000453:epidemiology