Massachusetts Chapter of the American College of Surgeons

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Early in-hospital mortality after elective open repair for abdominal aortic aneurysm
Thomas W. Cheng1, M.S., Alik Farber1, M.D., M.B.A., Scott R. Levin1, M.D., Nkiruka Arinze1, M.D., Virendra I. Patel2, M.D., Ogheneyoma Akpoviroro1, M.D., Denis Rybin3, Ph.D., Jeffrey J. Siracuse1, M.D., M.B.A.
1Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA; 2Division of Vascular Surgery and Endovascular Interventions, New York-Presbyterian/Columbia University Medical Center, Columbia University College of Physicians and Surgeons, New York, NY; 3Department of Biostatistics, Boston University, School of Public Health, Boston, MA

Background:
Early mortality after open abdominal aortic aneurysm (AAA) repair may represent a technical complication or poor patient selection. Our study’s objective was to analyze in-hospital death within the first 2 postoperative days (POD) after elective AAA repair.

Methods:
The Vascular Quality Initiative database was queried from 2003-2019 for elective open AAA repairs. Operations were categorized as those with in-hospital POD 0-2 death, in-hospital POD ?3 death, and without in-hospital death. Univariable and multivariable analyses were performed.

Results:
There were 7592 elective open AAA repairs with 61(.8%) in-hospital POD 0-2 death, 156(2.1%) in-hospital POD ?3 death, and 7375(97.1%) without in-hospital death. Overall, mean age was 69.3 years. Iliac aneurysm repair and surgical approach were similar amongst groups. In-hospital POD 0-2 deaths, compared to in-hospital POD ?3 death and without in-hospital death, had the longest renal/visceral ischemia time (mean, mins)(38.6vs. 22.5vs. 17.9), and most commonly had proximal clamp placement above both renal arteries (36.7%vs. 25.8%vs. 21.5%), aortic distal anastomosis (54.2%vs. 42.2%vs. 44%), and occluded inferior mesenteric artery at case completion (60%vs. 41.8%vs. 38%)(all P<.05). In-hospital POD 0-2 deaths most frequently had postoperative vasopressor use, myocardial infarction, stroke, and return to the operating room, and were least frequently extubated in the operating room (all P<.001). In multivariable analysis, in-hospital POD 0-2 death was associated with CHF, prior PVI, female sex, preoperative aspirin use, lower center volume quartile, renal/visceral ischemia time, EBL, and age (all P<.05).

Conclusion:
In-hospital POD 0-2 deaths were associated with patient comorbidities, center volume, renal/visceral ischemia time, and EBL.


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