Influence of preoperative medical assessment prior to elective endovascular aneurysm repair for abdominal aortic aneurysm.
OBJECTIVE
The aim of this study was to compare preoperative patient evaluation by a vascular physician with a standardized workup protocol prior to elective endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA), in terms of differences in patient medication and mortality.


METHODS
Consecutive patients with infrarenal AAA treated with standard EVAR from 1998 to 2006 (group 2) and 2007 to 2011 (group 1) were compared. Patients in group 1 (N.=201) were investigated preoperatively by a vascular physician, evaluating comorbidities and medication. Patients in group 2 (N.=304) underwent a standardized preoperative work-up including spirometry and echocardiography. Median time of follow-up was 23 months in group 1 and 71 months in group 2.


RESULTS
The proportion of patients who had on-going medication with anti-platelet and lipid lowering medication at admission was higher in group 1 compared to group 2 (62% versus 51%; P=0.013 and 68% versus 35%; P<0.001). In group 1, the proportion of newly instituted or increased dosage of anti-hypertensive, anti-platelet or lipid lowering medication at preoperative evaluation was 40%, 24% and 31%, respectively. The total cost for preoperative assessment per patient was 272 € in group 1 and 293 € in group 2 (P<0.001). There was no difference in 30-day (P=0.29) or long-term (P=0.24) mortality between the two groups.


CONCLUSIONS
Preoperative assessment by a vascular physician resulted in lower costs and improvement of medication against atherosclerosis, uncontrolled hypertension and perioperative ischemic cardiac events, but mortality was unaffected.
Department of Surgery, Eksjö County Hospital, Eksjö, Sweden.
T
T
Ohrlander
S
S
Nessvi
A
A
Gottsäter
M
M
Dencker
S
S
Acosta
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D002317:Cardiovascular Agents / Q000191:economics / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D015897:Comorbidity; D019937:Diagnostic Techniques and Procedures / Q000191:economics; D004452:Echocardiography; D017558:Elective Surgical Procedures; D004562:Electrocardiography; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D005260:Female; D017721:Hospital Costs; D006801:Humans; D053208:Kaplan-Meier Estimate; D007677:Kidney Function Tests; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000191:economics / Q000379:methods*; D018570:Risk Assessment; D012307:Risk Factors; D013147:Spirometry; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome
D002317:Cardiovascular Agents