BACKGROUND: The study was conducted to demonstrate improved survival (30-day mortality) after the introduction of an emergency endovascular therapy protocol for @entity1755 ( @entity1755 ). Numerous authors have successfully demonstrated reduced mortality in @entity1 with @entity1755 using endovascular techniques. @entity439 repair (EVAR) with open repair for @entity1755 may be misleading, however, because EVAR cannot be performed on all @entity1 , and selection bias may explain the superior performance of any given surgical or endovascular strategy. We developed a model to predict mortality in @entity1 before the introduction of EVAR (preprotocol population), applied this model to predict 30-day mortality among prospective @entity1 (postprotocol population), and compared observed vs expected results. METHODS: We assessed 126 @entity1 with @entity1755 . Primary outcome was 30-day mortality. Potential confounding variables were age, sex, presurgical lowest recorded systolic blood pressure (SBP), and glomerular filtration rate (GFR). A logistic regression model incorporating significant confounders was used to evaluate changes in 30-day mortality for all @entity1 with @entity1755 after introduction of the EVAR protocol. Separate logistic regressions were done to compare 30-day mortality for preprotocol vs @entity1 receiving EVAR and preprotocol vs @entity1 receiving postprotocol open repair. Cumulative sum (CUSUM) analysis was used to assess shifts in the performance of the @entity1755 program over time. RESULTS: Significant confounders were SBP, absence of SBP, and GFR. Logistic regression found evidence of lower mortality after the protocol was introduced, 17.9% vs 30.0% (odds ratio [OR], 0.385; 95% confidence interval [CI], 0.141 to 0.981; P = .046). Comparison of all open repairs (preprotocol and postprotocol) and EVAR demonstrated decreased risk for EVAR of 5.0% vs 28.3% (OR, 0.109; 95% CI, 0.013 to 0.906; P = .0084). Unstable @entity1 (SBP <or=80) showed a trend towards improved survival with EVAR relative to open repair (14.3% vs 56.0%, P = .061). Comparison of preprotocol surgery with open repair after the introduction of the protocol found no evidence of a difference between mortality rates for the open procedures-30.0% (preprotocol) vs 25.0% (postprotocol; OR, 0.688; 95% CI, 0.335 to 1.415, P = .3031)-demonstrating that the improved performance observed with CUSUM analysis was related to the introduction of the EVAR protocol. CONCLUSION: Our predictive model using "weighted" CUSUM analysis (a measure of performance over time) demonstrated that a predefined strategy of management of @entity1755 that includes EVAR is associated with improved (P < .05) mortality. Unstable @entity1 with @entity1755 may be particularly benefited by EVAR and should not be excluded from repair. Appropriate @entity1 with @entity1755 who are undergoing treatment in experienced vascular centers should be offered EVAR as the treatment of choice.

Improved survival after introduction of an emergency endovascular therapy protocol for XXXX .

@entity1 :: ('9606', 'Species') :: ['patients'] @entity439 :: ('MESH:D000783', 'Disease') :: ['Comparison of endovascular aneurysm'] @entity1755 :: ('MESH:D001019', 'Disease') :: ['ruptured abdominal aortic aneurysms', 'rAAA']
@entity1755 :: (MESH:D001019,Disease) :: ['ruptured abdominal aortic aneurysms']
