Improved trends in patient survival and decreased major complications after emergency ruptured abdominal aortic aneurysm repair.
BACKGROUND
Improved trends in patient survival and decreased major complications after emergency ruptured abdominal aortic aneurysm (AAA) repair. Emergency AAA repair carries a high risk of morbidity and mortality. This study seeks to examine morbidity and mortality trends from the National Surgical Quality Improvement Program (NSQIP) database, and identify potential risk factors.


METHODS
All emergency AAA repairs were identified using the NSQIP database from 2005 to 2011. Univariate analysis (using the Student t, χ(2), and Fisher's exact tests) and multivariate logistic regression was performed to examine trends in mortality and morbidity.


RESULTS
Out of 2761 patients who underwent emergency AAA repair, 321 (11.6%) died within 24 hours of surgery. Of the remaining 2440 patients, 1133 (46.4%) experienced major complications and 459 (18.8%) died during the postoperative period. From 2005 to 2011, there was a significant decrease in patient mortality, particularly in patients who survived the perioperative period (P = .002). Total complications increased overall (P < .0001); however, major complications decreased from 58.7% in 2005 to 42.6% in 2011 (P < .0001) among patients who survived beyond 24 hours. The use of endovascular aortic repair (EVAR) increased over the study period (P < .0001). On multivariate analysis of patients who survived past the initial 24-hour period, advancing age (odds ratio [OR], 1.1; 95% confidence interval [CI], 1.0-1.1), chronic obstructive pulmonary disease (OR, 2.6; 95% CI, 1.7-4.1), dependent functional status (OR, 2.0; 95% CI, 1.2-3.2), and presence of a major complication (OR, 3.1; 95% CI, 2.0-5.0) were significantly associated with death, whereas presence of a senior resident (OR, 0.4; 95% CI, 0.3-0.6) or fellow (OR 0.3; 95% CI, 0.2-0.6) was inversely associated with death. EVAR was not associated with death, but was associated with 30-day complications (OR, 0.5; 95% CI, 0.3-0.6).


CONCLUSIONS
Patient survival has increased from 2005 to 2011 after emergency AAA repair, with a significant improvement particularly in patients who survive past the first 24 hours. EVAR was not associated with mortality, but was protective of 30-day complications. Although the total number of complications increased, the number of major complications decreased over the study period, suggesting that newer techniques and patient care protocols may be improving outcomes.
Division of Vascular Surgery, Emory University School of Medicine, Atlanta, Ga.
Reshma
R
Brahmbhatt
Department of Surgery, Emory University School of Medicine, Atlanta, Ga.
Jennifer
J
Gander
Division of Vascular Surgery, Emory University School of Medicine, Atlanta, Ga.
Yazan
Y
Duwayri
Division of Vascular Surgery, Emory University School of Medicine, Atlanta, Ga.
Ravi R
RR
Rajani
Division of Vascular Surgery, Emory University School of Medicine, Atlanta, Ga.
Ravi
R
Veeraswamy
Division of Vascular Surgery, Emory University School of Medicine, Atlanta, Ga; Surgical Services, Atlanta VA Medical Center, Decatur, Ga.
Atef
A
Salam
Division of Vascular Surgery, Emory University School of Medicine, Atlanta, Ga.
Thomas F
TF
Dodson
Division of Vascular Surgery, Emory University School of Medicine, Atlanta, Ga; Surgical Services, Atlanta VA Medical Center, Decatur, Ga. Electronic address: shipra.arya@emory.edu.
Shipra
S
Arya
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D002170:Canada; D016009:Chi-Square Distribution; D016208:Databases, Factual; D004630:Emergencies; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality; D017064:Process Assessment, Health Care / Q000639:trends*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000639:trends*