Predictive factors for mortality after open repair of paravisceral abdominal aortic aneurysm

Prateek K. Gupta, Jason N Mactaggart, Bala Natarajan, Thomas G. Lynch, Shipra Arya, Himani Gupta, Xiang Fang, Iraklis I Pipinos

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective: The use of fenestrated and branched stent graft technology for paravisceral abdominal aortic aneurysms (PAAA) is on the rise; however, its application is limited in the United States to only a few selected centers. Most PAAAs are currently repaired using an open approach. The objective of this study was to determine which patients are at highest risk with open PAAA repair and might benefit most from endovascular repair using fenestrated or branched stent grafts. Methods: This was a retrospective cohort study using data from American College of Surgeons National Surgical Quality Improvement Program (NSQIP) hospitals. We identified 598 patients (27.5% women) who underwent elective open PAAA repair from the 2007 to 2009 NSQIP, a prospective database maintained at >250 centers. The main outcome measure was 30-day postoperative mortality. Results: The median patient age was 73 years. The 30-day major morbidity rate was 30.1%, and the mortality rate was 4.5%. Major complications included reintubation (10.0%), sepsis (10.7%), return to operating room (9.2%), new dialysis requirement (5.9%), cardiac arrest or myocardial infarction (4.5%), and stroke (1.2%). Multivariate analyses identified four predictors of postoperative mortality after open PAAA repair: peripheral arterial disease (PAD) requiring revascularization or amputation, chronic obstructive pulmonary disease (COPD), anesthesia time, and female sex. PAD and COPD were present in only 5.2% and 20.4% of patients but were associated with a 16.1% and 9.0% mortality rate, respectively. The mortality rate in women was 7.3% vs 3.5% for men (P =.045). Conclusions: PAD, COPD, and female sex are major risk factors for postoperative mortality after open PAAA repair. Fenestrated or branched stent graft repair may be a more valuable alternative to open repair for patients with one or more of these characteristics who have suitable access vessels.

Original languageEnglish (US)
Pages (from-to)666-673
Number of pages8
JournalJournal of vascular surgery
Volume55
Issue number3
DOIs
StatePublished - Mar 1 2012

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Abdominal Aortic Aneurysm
Mortality
Peripheral Arterial Disease
Chronic Obstructive Pulmonary Disease
Stents
Quality Improvement
Transplants
Operating Rooms
Heart Arrest
Amputation
Dialysis
Sepsis
Cohort Studies
Multivariate Analysis
Anesthesia
Retrospective Studies
Stroke
Myocardial Infarction
Outcome Assessment (Health Care)
Databases

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Predictive factors for mortality after open repair of paravisceral abdominal aortic aneurysm. / Gupta, Prateek K.; Mactaggart, Jason N; Natarajan, Bala; Lynch, Thomas G.; Arya, Shipra; Gupta, Himani; Fang, Xiang; Pipinos, Iraklis I.

In: Journal of vascular surgery, Vol. 55, No. 3, 01.03.2012, p. 666-673.

Research output: Contribution to journalArticle

Gupta, Prateek K. ; Mactaggart, Jason N ; Natarajan, Bala ; Lynch, Thomas G. ; Arya, Shipra ; Gupta, Himani ; Fang, Xiang ; Pipinos, Iraklis I. / Predictive factors for mortality after open repair of paravisceral abdominal aortic aneurysm. In: Journal of vascular surgery. 2012 ; Vol. 55, No. 3. pp. 666-673.
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AU - Gupta, Prateek K.

AU - Mactaggart, Jason N

AU - Natarajan, Bala

AU - Lynch, Thomas G.

AU - Arya, Shipra

AU - Gupta, Himani

AU - Fang, Xiang

AU - Pipinos, Iraklis I

PY - 2012/3/1

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N2 - Objective: The use of fenestrated and branched stent graft technology for paravisceral abdominal aortic aneurysms (PAAA) is on the rise; however, its application is limited in the United States to only a few selected centers. Most PAAAs are currently repaired using an open approach. The objective of this study was to determine which patients are at highest risk with open PAAA repair and might benefit most from endovascular repair using fenestrated or branched stent grafts. Methods: This was a retrospective cohort study using data from American College of Surgeons National Surgical Quality Improvement Program (NSQIP) hospitals. We identified 598 patients (27.5% women) who underwent elective open PAAA repair from the 2007 to 2009 NSQIP, a prospective database maintained at >250 centers. The main outcome measure was 30-day postoperative mortality. Results: The median patient age was 73 years. The 30-day major morbidity rate was 30.1%, and the mortality rate was 4.5%. Major complications included reintubation (10.0%), sepsis (10.7%), return to operating room (9.2%), new dialysis requirement (5.9%), cardiac arrest or myocardial infarction (4.5%), and stroke (1.2%). Multivariate analyses identified four predictors of postoperative mortality after open PAAA repair: peripheral arterial disease (PAD) requiring revascularization or amputation, chronic obstructive pulmonary disease (COPD), anesthesia time, and female sex. PAD and COPD were present in only 5.2% and 20.4% of patients but were associated with a 16.1% and 9.0% mortality rate, respectively. The mortality rate in women was 7.3% vs 3.5% for men (P =.045). Conclusions: PAD, COPD, and female sex are major risk factors for postoperative mortality after open PAAA repair. Fenestrated or branched stent graft repair may be a more valuable alternative to open repair for patients with one or more of these characteristics who have suitable access vessels.

AB - Objective: The use of fenestrated and branched stent graft technology for paravisceral abdominal aortic aneurysms (PAAA) is on the rise; however, its application is limited in the United States to only a few selected centers. Most PAAAs are currently repaired using an open approach. The objective of this study was to determine which patients are at highest risk with open PAAA repair and might benefit most from endovascular repair using fenestrated or branched stent grafts. Methods: This was a retrospective cohort study using data from American College of Surgeons National Surgical Quality Improvement Program (NSQIP) hospitals. We identified 598 patients (27.5% women) who underwent elective open PAAA repair from the 2007 to 2009 NSQIP, a prospective database maintained at >250 centers. The main outcome measure was 30-day postoperative mortality. Results: The median patient age was 73 years. The 30-day major morbidity rate was 30.1%, and the mortality rate was 4.5%. Major complications included reintubation (10.0%), sepsis (10.7%), return to operating room (9.2%), new dialysis requirement (5.9%), cardiac arrest or myocardial infarction (4.5%), and stroke (1.2%). Multivariate analyses identified four predictors of postoperative mortality after open PAAA repair: peripheral arterial disease (PAD) requiring revascularization or amputation, chronic obstructive pulmonary disease (COPD), anesthesia time, and female sex. PAD and COPD were present in only 5.2% and 20.4% of patients but were associated with a 16.1% and 9.0% mortality rate, respectively. The mortality rate in women was 7.3% vs 3.5% for men (P =.045). Conclusions: PAD, COPD, and female sex are major risk factors for postoperative mortality after open PAAA repair. Fenestrated or branched stent graft repair may be a more valuable alternative to open repair for patients with one or more of these characteristics who have suitable access vessels.

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