PATRIZIO CASTELLI
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Transcript of PATRIZIO CASTELLI
PATRIZIO CASTELLI
CHIRURGIA VASCOLAREDIPARTIMENTO DI SCIENZE CHIRURGICHE E MORFOLOGICHE
UNIVERSITA’ DEGLI STUDI DELL’INSUBRIAA.O.U. OSPEDALE DI CIRCOLO E “FONDAZIONE MACCHI” - VARESE
L’ ANEURISMA AORTICOADDOMINALE
• Holt PJE, et al. Provider volume and long-term outcome after elective abdominal aortic aneurysm repair.Br J Surg 2012;99:666-672
• Dimick JB, et al. Surgeon specialty and provider volumes are related to outcome of intact aabdominal aortic aneurysm repair in the United States.J Vasc Surg 2003;38:739-744
• Barshes NR, et al. Increasing complexity in the open surgical repair of abdominal aortic aneurysms.Ann Vasc Surg 2012;26:10-17
• Schanzer A, et al. Vascular surgery training trends rfom 2001-2007: a substantial increase in total procedure volume is driven by escalating endovascularprocedure volume and stable open procedure volume.J Vasc Surg 2009;49:1339-1344
• McPhee JT, et al. Surgeon case volume, not institution case volume, is the primary determinant of in-hospital mortality after elective open abdominalaortic aneurysm repair.J Vasc Surg 2011;53:591-599
• Landon BE, et al. Volume-outcome relationship and abdominal aortic aneurysm repair.Circulation 2010;122:1290-1297
• Hill JS, et al. Regionalization of abdominal aortic aneurysm repair: evidence of a shift to high-volume centers in the endovascular era.J Vasc Surg 2008;48:29-36
• Chadi SA, et al. Trend in management of abdominal aortic aneurysmsJ Vasc Surg 2012;55:924-928
• Grant SW, et al. Evaluation of five risk prediction models for elective abdominal aortic aneurysm repair using the UK National Vascular databaseBr J Surg 2012;99:673-679
• Brown LC, et al. Use of baseline factors to predict complications and reinterventions after endovascular repair of abdominal aortic aneurysm.Br J Surg 2010;97:1207-1217
IUXTARENALE P.A.U. DISSECANTEPSEUDOSOTTORENALE
• PREVALENZA DIAGNOSI di A.A.A.
TRATTAMENTO di A.A.A.
ROTTI
INTATTI
“SHIFT OF THE PARADIGM”
• CASI EVAR
• CASI ASA IV
• CASI 80enni
• COMPLICANZE: TASSO PIU’ ELEVATO @ 30g-6m
• SOPRAVVIVENZA SOVRAPPONIBILE > 2y
•
•
• DEFINIZIONE VOLUME
DELL’OSPEDALE (“PROVIDER”)
DEL CHIRURGO
RIFERIMENTO CONDIVISO: > 30 CASI/y
40.3%
59.7%
• MORTALITA’ HVH
SUPERIORITA’ ESTESAAD OLTRE 2 ANNI
STRETTAMENTE CORRELATAA MORTALITA’ @ 30d
“SECONDARY MANAGEMENT”
NONOSTANTE“HIGH RISK”
• HVH HANNO ADOTTATO EVAR RAPIDAMENTE E CON MAGGIOR ESTENSIVITA’ DI CASI
• PIU’ FREQUENTEMENTE NEL CONTESTO DI HVH
• PIU’ FREQUENTEMENTE SONO HVS
• MA SOLO 27% DEGLI A.A.A. TRATTATI DA CH VASCOLARI
• rA.A.A. PIU’ FREQUENTEMENTE OPERATI DA GENERALI
• MORTALITA’ A.A.A. DETERMINATA DA
“EFFETTO ADDITIVO”:VOLUME ANNUALEDI CHIRURGO E HOSP
DISCIPLINA DISPECIALIZZAZIONE
TEACH44.6%
62.9%
HIGH VOLUMEHOSPITAL (A.A.A.)
URBAN29.2%
N-TEACH12.6%
RURAL3.4%
34.2%
EVAR
• NUM DEI CLAMP SOVRARENALE (14.1% vs 30.3%)
• CLAMP SOVRARENALE SOPRAVVIVENZA, @5-10y (P = .04)
• COMPLICANZE PER CLAMP SOVRARENALE (25.8% vs 31.9%)