title: The effect of secondary operations on mortality following abdominal aortic aneurysm repair in the United States: 1988-2001.
abstract: Certain complications following open repair of abdominal aortic aneurysms (AAAs) require additional operations or invasive procedures. The purpose of this study was to determine the effect of secondary interventions on mortality rate following open repair of intact and ruptured AAAs in the United States. Clinical data on 98,193 patients treated from 1988 to 2001 with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) primary procedure code 38.44 (resection of the abdominal aorta with replacement) were analyzed. Demographic factors, types of secondary interventions, and in-hospital mortality rates were assessed by univariate and multivariate logistic regression analysis (SPSS Version 11.0, Chicago, IL). The database utilized in this study was The Nationwide Inpatient Sample (NIS). The mortality rate was 4.5% in the intact AAA group and 45.5% in the ruptured AAA group. The rate of secondary operations and procedures was much higher in the ruptured AAA group, especially related to renal failure (5.52% vs 1.49%, p <0.001); respiratory failure (3.67% vs 0.71%, p <0.001); postoperative bleeding (2.41% vs 0.81%, p <0.001); or colonic ischemia (2.38% vs 0.36%, p <0.001). Increased mortality following open repair of intact AAAs accompanied: peripheral artery angioplasty/stenting (OR, 1.25; 95% CI, 1.04-1.51; p = 0.018); coronary artery angioplasty/stenting (OR, 1.68; 95% CI, 1.05-2.70; p = 0.031); inferior vena cava (IVC) filter placement (OR, 2.02; 95% CI, 01.31-3.1; p = 0.001); vascular reconstruction or thromboembolectomy (OR, 2.05; 95% CI, 1.9-2.22; p <0.001); lower extremity amputation (OR, 4.09; 95% CI, 2.78-6.0; p <0.001); coronary artery bypass (OR, 6.71; 95% CI, 3.74-12.03; p <0.001); operations for postoperative bleeding (OR, 6.92; 95% CI, 5.71-8.4; p <0.001); initiation of hemodialysis (OR, 10.52; 95% CI, 9.22-12.01; p <0.001); tracheostomy (OR, 11.9; 95% CI, 9.86-14.37; p <0.001); and colectomy (OR, 16.22; 95% CI, 12.55-20.95; p <0.001). Increased risk of mortality following open repair of ruptured AAAs accompanied the following: operations for postoperative bleeding (OR, 1.5; 95% CI, 1.22-1.85; p <0.001); colectomy (OR, 1.63; 95% CI, 1.32-2.01; p <0.001); and initiation of hemodialysis (OR, 2.66; 95% CI, 2.30-3.08; p <0.001). The only independent variable in this group associated with decreased risk of in-hospital mortality was IVC filter placement (OR, 0.41; 95% CI, 0.27-0.64; p <0.001). This study confirms the perception that additional operations or invasive procedures following open repair of AAA entail significantly worse in-hospital mortality rates, especially when related to colonic ischemia, respiratory failure, and renal failure.
authors.affiliation: Surgical Outcomes Research Team (SORT), Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI 48109-0329, USA.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Eliason
authors.forename: Reid M
authors.initials: RM
authors.lastname: Wainess
authors.forename: Justin B
authors.initials: JB
authors.lastname: Dimick
authors.forename: John A
authors.initials: JA
authors.lastname: Cowan
authors.forename: Peter K
authors.initials: PK
authors.lastname: Henke
authors.forename: James C
authors.initials: JC
authors.lastname: Stanley
authors.forename: Gilbert R
authors.initials: GR
authors.lastname: Upchurch
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D002423:Cause of Death; D016001:Confidence Intervals; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011336:Probability; D012042:Registries; D012086:Reoperation / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods