title: Trends in Patient Safety of Intact Abdominal Aortic Aneurysm Repair: German Registry Data on 36,594 Procedures.
abstract: OBJECTIVE
  The study aim was to determine whether patient safety for non-ruptured abdominal aortic aneurysm (nrAAA) repair has changed between 1999 and 2010 in a large German cohort.
  
  
  METHODS
  The data source was the prospective quality assurance registry of the German Vascular Society from 1999 to 2010. Patient characteristics, surgical techniques (open aortic repair [OAR], endovascular aortic repair [EVAR]), procedural time and outcomes, including the length of hospital stay (LOS), were analysed using the Cochran-Armitage test for binary parameters and Spearman's correlation coefficient for quantitative parameters.
  
  
  RESULTS
  A total of 36,594 operations (23,037 OAR, 13,557 EVAR) for infrarenal nrAAA in 201 hospitals in Germany were investigated. Patients' mean age increased from 69.6 to 72.0 years (p < .001). The rate of patients with American Society of Anesthesiologists scores of 3 or 4 increased (p < .001). Use of EVAR increased (1999: 16.7%; 2010: 62.7%; p < .001), and since 2009, EVAR has been more frequently used than OAR. The overall in hospital mortality decreased from 3.1% in 1999 to 2.3% in 2010 (p < .001). There were no temporal trends for mortality rates for EVAR (p = .233) or OAR (p = .281) when considered separately. Cardiac (1999: 8.1%; 2010: 5.1%; p < .001) and pulmonary (1999: 7.8%; 2010: 4.8%; p < .001) complications decreased. The rate of post-operative renal failure increased (1999: 3.6%; 2010 4.1%; p = .017), without increasing the rate of patients needing dialysis (1999: 1.7%; 2010: 1.7%; p = .171). The median LOS decreased from 17 days in 1999 to 10 days in 2010 (p < .001).
  
  
  CONCLUSIONS
  This study shows significantly improved post-procedural in hospital outcomes and decreased use of resources for nrAAA repair. This trend can probably be attributed to the implementation of EVAR as a standard technique, but some trends could also possibly be explained by a change in the remuneration system. The main limitation of the registry is the lack of internal and external validation. However, in hospital patient safety for AAA repair seems to have improved significantly in the participating hospitals.
authors.affiliation: Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Trenner
authors.affiliation: Institute for Medical Statistics and Epidemiology, Technical University of Munich, Munich, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Haller
authors.affiliation: Department for Vascular and Thoracic Surgery, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany; Commission for Quality and Safety, German Vascular Society (Deutsche Gesellschaft für Gefäßchirurgie und Gefäßmedizin, DGG), Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Storck
authors.affiliation: Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Reutersberg
authors.affiliation: Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: M A
authors.initials: MA
authors.lastname: Kallmayer
authors.affiliation: Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. Electronic address: hans-henning.eckstein@mri.tum.de.
authors.forename: H-H
authors.initials: HH
authors.lastname: Eckstein
mesh_terms: 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*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D005260:Female; D005858:Germany; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D058996:Quality Improvement / Q000639:trends; D019984:Quality Indicators, Health Care / Q000639:trends; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Abdominal aortic aneurysm; Endovascular aortic repair; Open aortic repair; Patient safety; Quality assurance