Abstract
Background
To analyse 19 years’ worth of data from a Major UK Vascular Centre to determine the
outcome of patients after they enter abdominal aortic aneurysm (AAA) surveillance
(surgery, death, discharge or transfer), this may inform interventions to improve
these outcomes in the AAA surveillance population.
Methods
This was a retrospective analysis of a prospectively collected database of outcomes
of every patient entered on AAA surveillance at Manchester University NHS Foundation
Trust – Wythenshawe Hospital between September 2000 and June 2019. Analyses included
what proportion suffered death, discharge, transfer or surgery whilst on surveillance.
Multi-variate analysis was used to determine the effect of initial AAA size, age when
entering surveillance and gender. Boxplots were produced in those who had already
reached an outcome to determine historic median times. Causes of death/discharge were
also analysed.
Results
One thousand nine hundred fifty-one patients were identified from the databased after
data cleaning and were included in the final analysis. Thirty-two percent of patients
had died, 23.8% had surgery, 13.3% were discharged due to worsening/severe comorbidity,
3.1% had been transferred and 27.7% were still active in surveillance. A longer time
to surgery was significantly associated with increasing age on entering surveillance
OR (95% CI) 0.95 (0.94–0.96) (P < 0.001), smaller initial AAA size 4.26 (3.80–4.78) (P < 0.001) but not female gender. Impaired survival was associated with increasing
age 1.06 (1.05–1.07) (P < 0.001), initial AAA size, 1.56 (1.39–1.74) (P < 0.001) and female gender 1.40 (1.18–1.67) (P < 0.001). Overall, death occurred more frequently than operative repair every year
over all 15 years. Out of the deaths where cause was known (n = 401), 34.9% (n = 108)
were due to cardiovascular events, 27.3% (n = 109) due to malignancy (primarily lung),
and 19.3% due to respiratory disease.
Conclusions
Based on this data, death, primarily due to cardiovascular events, is a more likely
outcome than operative repair in patients on AAA surveillance and is associated with
increasing age, increasing AAA size and female gender. A median time on surveillance
of over three and a half years provides sufficient time to affect subsequent health
outcomes in this population and therefore a shift of focus of AAA surveillance programmes
to address cardiovascular, malignancy and respiratory disease risk is warranted.
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Article Info
Publication History
Published online: December 18, 2021
Accepted:
November 10,
2021
Received in revised form:
November 2,
2021
Received:
October 3,
2021
Footnotes
Declaration of Interest: The authors declare that there is no conflict of interest.
Identification
Copyright
Crown Copyright © 2021 Published by Elsevier Inc. All rights reserved.
