title: Predictors of decreased short- and long-term survival following open abdominal aortic aneurysm repair.
abstract: OBJECTIVE
  The purpose of this study was to identify predictors of decreased survival after open abdominal aortic aneurysm (AAA) repair at a single university hospital.
  
  
  METHODS
  Patients undergoing open AAA repair from June 2003 to June 2009 were identified. Primary outcomes were 30-day and 5-year survival. Preoperative, intraoperative, and postoperative variables were assessed for their influence on outcomes using univariate and multivariate analysis, as appropriate. One- and 5-year survival were determined by Kaplan-Meier analysis.
  
  
  RESULTS
  Four hundred eight patients (289 men; 70.8%) with a mean age of 72.4 ± 8.3 years underwent open AAA repair. Sixty-seven patients (16.4%) underwent nonelective repair. The clamp site was infrarenal in 137 patients (33.6%), suprarenal in 97 patients (23.8%), and supraceliac in 174 patients (42.6%). Thirty-day survival was 95.6%. One- and 5-year survival were 90.0% ± 1.5% and 65.1% ± 3.0%, respectively. Seventy-nine patients (19.4%) had decreased renal function postoperatively compared to preoperatively, 71 patients (17.4%) sustained cardiac complications, and 45 patients (11.0%) sustained pulmonary complications. Patients with chronic obstructive pulmonary disease (91.9% vs 97.2%; P = .004) and chronic renal insufficiency (92.0% vs 98.3%; P = .009) had decreased 30-day survival. Patients with chronic obstructive pulmonary disease (55.8% ± 5.8% vs 67.3% ± 3.6%; P = .013), chronic renal insufficiency (51.2% ± 5.2% vs 72.8% ± 3.7%; P = .043), and cerebrovascular disease (46.8% ± 7.4% vs 67.4% ± 3.4%; P = .003) had decreased 5-year survival. Patients who had decreased postoperative renal function (41.0% ± 7.4% vs 72.2% ± 3.4%; P = .004), and patients who sustained pulmonary complications (45.6% ± 8.8% vs 66.3% ± 3.3%; P = .042) had worse 5-year survival.
  
  
  CONCLUSIONS
  Open AAA repair can be done with low morbidity and mortality in the era of endovascular aneurysm repair. Careful consideration should be given to preoperative optimization and perioperative care in patients with chronic obstructive pulmonary disease, chronic renal insufficiency, and cerebrovascular disease. Postoperative decrease in renal function and pulmonary complication portend decreased 5-year survival; strategies to ameliorate these factors should be sought.
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, 4 Maloney Building, Philadelphia, PA 19104, USA. derek.nathan@uphs.upenn.edu
authors.forename: Derek P
authors.initials: DP
authors.lastname: Nathan
authors.forename: Clayton J
authors.initials: CJ
authors.lastname: Brinster
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Jackson
authors.forename: Grace J
authors.initials: GJ
authors.lastname: Wang
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Carpenter
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Fairman
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Woo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality* / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006785:Hospitals, University; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D015143:Philadelphia / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality*