Siena and St George Vascular Institute Risk Scoring Systems in Predicting the Cost-Effectiveness of EVAR

Yıl 2020, , 209 - 218, 30.12.2020

Ali Ahmet Arıkan , Şadan Yavuz Kamil Turan Berki

https://doi.org/10.25279/sak.626809

Öz

Objectives: Endovascular aneurysm repair (EVAR) is a
widely used modality in the treatment of abdominal aortic aneurysms (AAA).
Siena EVAR and St.George Vascular Institute (SGVI) scores are risk scores to
predict possible EVAR related reinterventions. This study was aimed to validate
the risk scores and compare the predictivity of the scoring systems for
hospital cost-effectiveness in our population.

Materials and Methods: 39 patients with unruptured
infrarenal AAA, including both elective and non-elective admissions which had a
follow-up period from at least 6 months are included in our study. Siena EVAR
score and SGVI score are calculated. The relation of the complications
(adjuncts at the index operation, reinterventions during follow up), costs
(index procedure and overall), aneurysm related mortality are compared among
the risk groups. 

Results: In our study, SGVI score had a predictivity
among high and low-risk groups involving reinterventions during follow up, cost
on index operation and mortality (P < 0.05). Siena EVAR score had no
significant predictivity (p > 0.05).

Conclusion: A high-risk value in SGVI score must warn
the surgeon to reassess the treatment option for AAA. If  EVAR is indicated the health care providers
and assurance system can count on a higher cost on index operation, a higher
risk of reintervention and mortality during long term follow up.

Anahtar Kelimeler

Aortic Aneurysm, Abdominal; Endovascular Procedures, risk assesment, Health Care Costs, reoperation

EVAR'ın Maliyet Etkinliğini Öngörmede Siena ve St George Vascular Institute Risk Skorlama Sistemleri

Öz

Amaç: Endovasküler anevrizma onarımı (EVAR), abdominal aort
anevrizmalarının (AAA) tedavisinde yaygın olarak kullanılan bir yöntemdir.
Siena EVAR ve St.George Vasküler Enstitüsü (SGVI) puanları, EVAR ile ilgili
olası müdahaleleri öngörmek için kullanılan risk puanlarıdır. Bu çalışmada,
risk skorlarını doğrulamak ve skorlama sistemlerinin popülasyonumuzda hastane
maliyet etkinliği için öngörülerini karşılaştırmak amaçlandı.

Gereç ve Yöntem: Çalışmamıza en az 6 ay takip süresine sahip
rüptüre olmayan infrarenal AAA'lı 39 hasta dahil edildi. Siena EVAR skoru ve
SGVI skoru hesaplandı. Risk grupları arasında komplikasyonların (ilk
operasyonundaki ek işlemler, takip sırasında girişim ihtiyacı), maliyet (ilk işlem
ve genel), anevrizmaya bağlı mortalite arasındaki ilişki karşılaştırıldı.

Bulgular: Çalışmamızda SGVI skoru yüksek riskli ve düşük
riskli grupları arasında, takip sırasında girişim ihtiyacı, ilk işlem maliyeti
ve mortalite açısından anlamlı fark bulundu (P ​​<0.05). Siena EVAR skorunun
anlamlı bir öngörücülüğü yoktu (p> 0.05).

Sonuç: SGVI skorundaki yüksek riskli bir değer, cerrahı AAA
için tedavi seçeneğini yeniden değerlendirmesi için uyarmalıdır. EVAR risk
gruplamasına göre, sağlık hizmeti sağlayıcıları ve sosyal güvence sistemi, ilk  işleminlerde daha yüksek bir maliyet ve uzun
süreli takip sırasında daha yüksek oranda yeniden girişim ihtiyacı  ve ölüm riskini hesaba katmalıdır .

Anahtar Kelimeler

Aort Anevrizması, Abdominal; Endovasküler İşlemler, Risk değerlendirmesi, Sağlık masrafları, reoperasyon

Kaynakça

• Aytekin, B., Akkaya, B. B., Yılmaz, M., Çetinkaya, F., Salman, N., Ünal, E. U., . . . Özatik, M. A. (2019). Applicability of ASA classification system in elective endovascular aneurysm repair. Turkish Journal of Vascular Surgery, 28(2).
• Best, W. B., Ahanchi, S. S., Larion, S., Ammar, C. P., Lavingia, K. S., & Panneton, J. M. (2016). Abdominal aortic aneurysm anatomic severity grading score predicts implant-related complications, systemic complications, and mortality. Journal of Vascular Surgery, 63(3), 577-584.
• Bulut, Ö., & Demirağ, M. K. (2013). Short and mid-term quality of life and outcomes following endovascular and open surgical repair of abdominal aortic aneurysms. Turkish Journal of Thoracic and Cardiovascular Surgery, 21(3), 639-645.
• Chaikof, E. L., Dalman, R. L., Eskandari, M. K., Jackson, B. M., Lee, W. A., Mansour, M. A., . . . Nguyen, L. L. (2018). The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. Journal of Vascular Surgery, 67(1), 2-77. e72.
• De Bruin, J. L., Karthikesalingam, A., Holt, P. J., Prinssen, M., Thompson, M. M., Blankensteijn, J. D., . . . Buth, J. (2016). Predicting reinterventions after open and endovascular aneurysm repair using the St George's Vascular Institute score. Journal of Vascular Surgery, 63(6), 1428-1433. e1421.
• Hastaoğlu, İ. O., Toköz, H., Bilginer, N., & Bilgen, F. (2014). Endovasküler stent greft orta dönem sonuçlarımız: Yüksek riskli hastalarda istenilen mortalitenin neresindeyiz? Türk Göğüs Kalp Damar Cerrahisi Dergisi, 22(3), 558-563.
• Hinchliffe, R., Braithwaite, B., & Hopkinson, B. (2003). The endovascular management of ruptured abdominal aortic aneurysms. European Journal of Vascular and Endovascular Surgery, 25(3), 191-201.
• Karthikesalingam, A., Holt, P., Hinchliffe, R., Nordon, I., Loftus, I., & Thompson, M. (2010). Risk of reintervention after endovascular aortic aneurysm repair. British Journal of Surgery, 97(5), 657-663.
• Karthikesalingam, A., Holt, P., Vidal‐Diez, A., Choke, E., Patterson, B., Thompson, L., . . . Thompson, M. (2013). Predicting aortic complications after endovascular aneurysm repair. British Journal of Surgery, 100(10), 1302-1311.
• Karthikesalingam, A., Vidal‐Diez, A., De Bruin, J., Thompson, M., Hinchliffe, R., Loftus, I., & Holt, P. (2015). International validation of a risk score for complications and reinterventions after endovascular aneurysm repair. British Journal of Surgery, 102(5), 509-515.
• Lübke, T., & Brunkwall, J. (2014). [Metaanalysis of EVAR versus open repair for patients undergoing elective repair of abdominal aortic aneurysms]. Zentralblatt für Chirurgie, 139(5), 552-561. doi: 10.1055/s-0032-1328356
• members, A. T. F., Erbel, R., Aboyans, V., Boileau, C., Bossone, E., Bartolomeo, R. D., . . . Frank, H. (2014). 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). European Heart Journal, 35(41), 2873-2926.
• Nilsson, J., Algotsson, L., Hoglund, P., Luhrs, C., & Brandt, J. (2004). EuroSCORE predicts intensive care unit stay and costs of open heart surgery. Annals of Thoracic Surgery, 78(5), 1528-1534. doi: 10.1016/j.athoracsur.2004.04.060
• Paraskevas, K. I., Bessias, N., Giannoukas, A. D., & Mikhailidis, D. P. (2010). Endovascular abdominal aortic aneurysm repair (EVAR) procedures: counterbalancing the benefits with the costs. Vascular and Endovascular Surgery, 44(4), 319-320.
• Patel, S. R., Allen, C., Grima, M. J., Brownrigg, J. R., Patterson, B. O., Holt, P. J., . . . Karthikesalingam, A. (2017). A systematic review of predictors of reintervention after EVAR: guidance for risk-stratified surveillance. Vascular and Endovascular Surgery, 51(6), 417-428.
• Powell, J. T., Sweeting, M. J., Ulug, P., Blankensteijn, J. D., Lederle, F., Becquemin, J. P., . . . Beard, J. (2017). Meta‐analysis of individual‐patient data from EVAR‐1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years. British Journal of Surgery, 104(3), 166-178.
• Prinssen, M., Wixon, C. L., Buskens, E., & Blankensteijn, J. D. (2004). Surveillance after endovascular aneurysm repair: diagnostics, complications, and associated costs. Annals of Vascular Surgery, 18(4), 421-427.
• Rutherford, R. B. (2006). Randomized EVAR trials and advent of level I evidence: a paradigm shift in management of large abdominal aortic aneurysms? Paper presented at the Seminars in Vascular Surgery.
• Sampaio, S. M., Shin, S. H., Panneton, J. M., Andrews, J. C., Bower, T. C., Cherry, K. J., . . . Gloviczki, P. (2009). Intraoperative endoleak during EVAR: frequency, nature, and significance. Vascular and Endovascular Surgery, 43(4), 352-359.
• Schanzer, A., & Messina, L. (2012). Two decades of endovascular abdominal aortic aneurysm repair: enormous progress with serious lessons learned. Journal of the American Heart Association, 1(3), e000075-e000075. doi: 10.1161/JAHA.111.000075
• Setacci, C., Sirignano, P., Fineschi, V., Frati, P., Ricci, G., & Speziale, F. (2017). A clinical and ethical review on late results and benefits after EVAR. Annals of medicine and surgery, 16, 1-6.
• Setacci, F., Sirignano, P., Galzerano, G., De, G. D., Ceriello, D., Paroni, G., . . . Setacci, C. (2012). Siena EVAR Score. The Journal of cardiovascular surgery, 53(2), 229-234.
• Skervin, A. L., Lim, C. S., & Sritharan, K. (2017). Improving Patient Compliance With Post-EVAR Surveillance May Prevent Late Rupture. Vascular and Endovascular Surgery, 51(7), 522-526.
• Yazman, S., Yürekli, İ., Yılık, L., Yetkin, U., İner, H., Güneş, T., . . . Gürbüz, A. (2016). Our mid-term results of endovascular repair of abdominal aortic aneurysms. Turkish Journal of Thoracic and Cardiovascular Surgery, 24(2), 274-280.