Long-term survival following successful abdominal aortic aneurysm repair evaluated using Australian administrative data.

Abstract

Long-term survival (LTS) following abdominal aortic aneurysm (AAA) surgery is an outcome that can compare open surgical repair (OSR) and endovascular AAA repair (EVAR) methods. We examined the LTS of persons following successful AAA repair using administrative health data covering the Australian Pharmaceutical Benefits and Medicare Benefits Schemes from 1993 to 2014. Participants undergoing AAA surgery were identified using procedure codes and the last service provision date used as a proxy mortality marker. LTS and relative survival with control populations in those who survived the initial post-operative period were used to compare OSR and EVAR and estimates between the first and second halves of the study. A total of 2060 persons who had undergone AAA repair were identified. Overall median LTS (95% CI) following elective, ruptured OSR and EVAR were 10.4 (9.1-11.0), 8.5 (6.7-10.3) and 9.7 (8.1-11.3) years, respectively. Relative survival rates at 5 and 10 years were 0.89 and 0.7 for OSR and 0.87 and 0.66 for EVAR. LTS rates were similar for OSR and EVAR in age groups 65-84 years (EVAR/OSR range 0.96-1.16); however, EVAR was superior to OSR in persons aged >85 years at 5 years (EVAR/OSR 1.32, log-rank P < 0.05). Relative survival following all techniques of AAA repair showed no significant change over the duration of the study. LTS following AAA repair was heterogeneous in comparison with control populations and varied with age and procedure. The 5-year LTS following EVAR in persons aged >85 years is superior to OSR. Administrative data can define long-term outcomes following aortic aneurysm surgery and may complement data already collected by surgeons.