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Objective
To assess trends in abdominal aortic aneurysm (AAA) hospital admissions, interventions, and aneurysm related mortality in England, and to examine the impact of endovascular repair on mortality for the years 1998 – 2020.
Methods
Hospital admission and operative approach (endovascular aortic aneurysm repair, or open surgical repair [OSR]) using Hospital Episodes Statistics (HES), and aneurysm related mortality data from the Office for National Statistics for England standardised to the 2013 European Standard Population, were analysed using linear regression and Joinpoint regression analyses. Aneurysm related mortality was compared between the pre-endovascular era (1998 – 2010) and the endovascular era (2011 – 2019).
Results
A declining trend in hospital admission incidence was observed, mainly due to a decline in ruptured admissions from 34.6 per 100 000 (95% confidence interval [CI] 33.5 – 35.6) to 13.5 per 100 000 (95% CI 12.9 – 14.2; βi = –1.04, r2 = .97, p < .001). Operative interventions have been declining over the last 23 years mainly due to the statistically significant decline in open procedures (41.2 per 100 000 in 2000 [95% CI 40 – 42.3] to 9.6 per 100 000 [95% CI 9.1 – 10.1]; βi = –1.92, r2 = .95; p < .001). There was an increasing trend toward endovascular procedures (5.8 per 100 000 [95% CI 5.3 – 6.2] in 2006 to 16.9 per 100 000 [95% CI 16.2 – 17.5] in 2020; βi = .82, r2 = .30, p = .040). Reductions in aneurysm related mortality due to AAAs were observed for males and females, irrespective of age and rupture status.
Conclusion
A significant decrease in hospital admissions for AAAs was observed over the last 23 years in England, paralleled by a shift toward endovascular repair and a decline in OSR. Declines in aneurysm related mortality were observed overall, and in the endovascular era irrespective of age, sex, and rupture status.
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Publication history
Accepted:
March 13,
2023
Received in revised form:
February 26,
2023
Received:
December 9,
2022
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 The Author(s). Published by Elsevier B.V. on behalf of European Society for Vascular Surgery.
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