title: Outcome in patients at high risk after open surgical repair of abdominal aortic aneurysm.
abstract: OBJECTIVE
  Outcomes after surgical repair of abdominal aortic aneurysm (AAA) in patients at high risk remain poorly defined. We investigated the short-term and long-term results of open repair of infrarenal AAA in a high-risk and comparison low-risk patient population.
  
  
  METHODS
  Conventional open surgical repair of nonruptured infrarenal AAA was performed in 572 consecutive patients from 1990 to 2000. Patients were considered at high risk if they had one or more of the following criteria: age 80 years or more, creatinine level 3.0 mg/dL or higher, severe pulmonary insufficiency, severe cardiac dysfunction, or hepatic failure. A retrospective review was carried out to determine relative risks, perioperative morbidity and mortality, and long-term survival. A P value of less than.05 was considered statistically significant.
  
  
  RESULTS
  One hundred twenty-eight of the study patients (22%) were at high risk and 444 were at low risk. Patients at high risk were older (77 versus 69 years; P <.001), were more likely female (26% versus 16%; P <.009), and had larger (mean, 5.9 versus 5.6 cm; P <.024), more symptomatic (20% versus 13%; P <.001) aneurysms. The 30-day operative mortality rate for the high-risk group was 4.7%, compared with 0.0% (P <.001) in the low-risk group. Overall and major morbidity rates were 29% and 14% in the high-risk cohort versus 17% (P <.003) and 5% in the low-risk cohort, respectively. The 5-year survival rate was 46% (standard deviation, 5.2%) in the high-risk group versus 74% (standard deviation, 2.6%) in the low-risk group (P <.001). On multivariate analysis, age 80 years or more (P <.046), creatinine level 3.0 mg/dL or higher (P <.022), prior stroke (P <.012), and pulmonary dysfunction were significant predictors of poor operative outcome (30-day mortality and major morbidity), and female gender (P <.035), cardiac dysfunction (P <.004), creatinine level 3.0 mg/dL or higher (P <.0001), prior stroke (P <.005), and pulmonary dysfunction (P <.0001) negatively impacted long-term survival rates.
  
  
  CONCLUSIONS
  This study shows that open repair of infrarenal AAA in patients at high risk can be performed with relative safety and with results that offer a benchmark with which endovascular repair can be compared. Poor long-term survival in this population, however, highlights the importance of patient selection and raises the question of whether repair of many patients at high risk is warranted.
authors.affiliation: Division of Vascular Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Menard
authors.forename: David K W
authors.initials: DK
authors.lastname: Chew
authors.forename: Rodney K
authors.initials: RK
authors.lastname: Chan
authors.forename: Michael S
authors.initials: MS
authors.lastname: Conte
authors.forename: Magruder C
authors.initials: MC
authors.lastname: Donaldson
authors.forename: John A
authors.initials: JA
authors.lastname: Mannick
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Whittemore
authors.forename: Michael
authors.initials: M
authors.lastname: Belkin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000009:adverse effects*