title: Medical optimisation can reduce morbidity and mortality associated with elective aortic aneurysm repair.
abstract: OBJECTIVE
  Patients with aortic aneurysms have significant comorbidities which influence outcome. Our practice includes comprehensive assessment to identify comorbidities, allowing subsequent medical optimisation prior to aneurysm repair. The aim of this study was to assess this process and to identify any factors predictive of outcome.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Medical case notes of 200 patients referred with aortic pathology.
  
  
  METHODS
  Data analysed included preoperative, perioperative and postoperative factors. Multiple logistic regression analysis was performed to identify predictors of outcome.
  
  
  RESULTS
  Following assessment 17 patients (8.5%) were found to be unfit for intervention and 165 patients (82.5%) proceeded to aneurysm repair. In this group assessment uncovered previously undiagnosed cardiac, respiratory and renal comorbidity in 19%, 57% and 29% of patients respectively. Multiple logistic regression analysis indicated that optimisation by a renal physician reduced post-operative renal impairment (OR 0.12, 95% CI 0.03-0.45, P=0.002) while optimisation by a cardiologist reduced respiratory complications (OR 0.7, 95% CI 0.05-0.99, P=0.049). An abnormal echocardiogram was associated with pneumonia (OR 6.9, 95% CI 1.6-29, P=0.01) and death (OR 7.9, 95% CI 1.15-54, P=0.036).
  
  
  CONCLUSIONS
  Pre-operative assessment identifies previously undiagnosed comorbidity in a significant proportion of patients. Subsequent medical optimisation may reduce post-operative morbidity and mortality.
authors.affiliation: St George's Vascular Institute, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Dawson
authors.forename: S
authors.initials: S
authors.lastname: Vig
authors.forename: E
authors.initials: E
authors.lastname: Choke
authors.forename: J
authors.initials: J
authors.lastname: Blundell
authors.forename: G
authors.initials: G
authors.lastname: Horne
authors.forename: C
authors.initials: C
authors.lastname: Downham
authors.forename: I
authors.initials: I
authors.lastname: Loftus
authors.forename: M M
authors.initials: MM
authors.lastname: Thompson
mesh_terms: D000368:Aged; D001014:Aortic Aneurysm / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000592:standards*; D011446:Prospective Studies; D012107:Research Design; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D018570:Risk Assessment; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures