PMID- 27102201 OWN - NLM STAT- MEDLINE DCOM- 20161213 LR - 20170203 IS - 1532-2165 (Electronic) IS - 1078-5884 (Linking) VI - 52 IP - 2 DP - 2016 Aug TI - Outcome After Open and Laparoscopic Aortic Surgery in Matched Cohorts Using Propensity Score Matching. PG - 179-88 LID - S1078-5884(16)00117-9 [pii] LID - 10.1016/j.ejvs.2016.02.021 [doi] AB - OBJECTIVE/BACKGROUND: To compare the post-operative and mid-term outcomes of laparoscopic aortic surgery with those of conventional aortic surgery performed by a surgical team trained in laparoscopic aortic surgery. METHODS: A prospective study was conducted between January 2006 and December 2011 with 228 consecutive patients having undergone aortic bypass surgery for either an abdominal aortic aneurysm (n = 139) or occlusive aorto-iliac disease (n = 89). Conventional open aortic surgery was carried out in 145 patients, and total laparoscopic repair in 83 patients. The composite primary end point measure grouped together the following adverse events (AEs): (1) any deaths < 30 days or later deaths related to the operation; (2) post-operative hemorrhage necessitating reoperation; (3) myocardial infarction /= 4 days; (6) aortic prosthesis infection; (7) aortic prosthesis occlusion; (8) any re-operation related to aortic surgery. In order to diminish bias attributable to the absence of randomization, the two surgical groups were matched by a propensity score enabling analysis of 50 pairs of patients having presented with identical pre-operative characteristics. Univariate analysis of the AE occurring during the first 30 post-operative days was followed by multivariate analysis through logistic regression. The rate of AE during follow up was calculated using the Kaplan-Meier method and the roles of the different co-variables were analyzed using the Cox model. RESULTS: Univariate analysis of the groups adjusted for propensity score showed that laparoscopic repair was associated with a significantly higher risk of AE over the first 30 post-operative days (p = .03). Logistic regression analysis showed that laparoscopic aortic technique (odds ratio [OR] 4.50; p = .01) and coronary artery disease (OR 4.67; p = .02) were independently related to the occurrence of an AE during the post-operative period. The occurrence of AEs during follow up was analyzed using the Cox model. Only two variables, laparoscopic aortic surgery (hazard ratio [HR] 4.40; p = .002) and coronary artery disease (HR 2.70, p = .02), were independently associated with the occurrence of an AE during follow up. The small number of patients included prevented a separate analysis with regard to aneurysmal and occlusive aortic disease. CONCLUSION: This study suggests that even with a well trained surgical team, the laparoscopic approach increases the risk for AEs observed in the course of aortic surgery. ClinicalTrials.gov Identifier: NCT02325700. CI - Copyright (c) 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved. FAU - Ricco, J-B AU - Ricco JB AD - Vascular Surgery Department, University of Poitiers, Poitiers 86021, France. Electronic address: jbricco2@mac.com. FAU - Cau, J AU - Cau J AD - Vascular Surgery Unit, Polyclinique de Poitiers, Poitiers 86000, France. FAU - Biancari, F AU - Biancari F AD - Department of Surgery, Oulu University Hospital, 90210 Oulu, Finland. FAU - Desvergnes, M AU - Desvergnes M AD - Vascular Surgery Department, University of Poitiers, Poitiers 86021, France. FAU - Lefort, N AU - Lefort N AD - Vascular Surgery Department, University of Poitiers, Poitiers 86021, France. FAU - Belmonte, R AU - Belmonte R AD - Vascular Surgery Department, University of Poitiers, Poitiers 86021, France. FAU - Schneider, F AU - Schneider F AD - Vascular Surgery Department, University of Poitiers, Poitiers 86021, France. LA - eng SI - ClinicalTrials.gov/NCT02325700 PT - Comparative Study PT - Journal Article DEP - 20160418 PL - England TA - Eur J Vasc Endovasc Surg JT - European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery JID - 9512728 SB - IM MH - Aged MH - Aorta, Abdominal/*surgery MH - Aortic Aneurysm, Abdominal/surgery MH - Arterial Occlusive Diseases/surgery MH - Female MH - Humans MH - Laparoscopy/adverse effects/*methods MH - Male MH - Middle Aged MH - Postoperative Complications/epidemiology/etiology MH - Propensity Score MH - Prospective Studies MH - Treatment Outcome OTO - NOTNLM OT - Aortic surgery OT - Laparoscopic repair OT - Laparoscopy OT - Propensity score EDAT- 2016/04/23 06:00 MHDA- 2016/12/15 06:00 CRDT- 2016/04/23 06:00 PHST- 2015/12/09 00:00 [received] PHST- 2016/02/29 00:00 [accepted] PHST- 2016/04/23 06:00 [entrez] PHST- 2016/04/23 06:00 [pubmed] PHST- 2016/12/15 06:00 [medline] AID - S1078-5884(16)00117-9 [pii] AID - 10.1016/j.ejvs.2016.02.021 [doi] PST - ppublish SO - Eur J Vasc Endovasc Surg. 2016 Aug;52(2):179-88. doi: 10.1016/j.ejvs.2016.02.021. Epub 2016 Apr 18.