title: The impact of exposure technique on perioperative complications in patients undergoing elective open abdominal aortic aneurysm repair.
abstract: OBJECTIVE
  The objective of this study was to evaluate the impact of exposure technique on perioperative complications in patients undergoing elective open abdominal aortic aneurysm (AAA) repair.
  
  
  METHODS
  Using the Society for Vascular Surgery Vascular Quality Initiative database, the study identified patients subjected to open AAA repair from January 2003 to July 2014 and divided them into two aortic exposure groups, retroperitoneal (RP) and transperitoneal (TP). Multivariable analysis was performed to compare the incidence of cardiac events (myocardial infarction, dysrhythmia, heart failure), prolonged intubation, renal dysfunction, and mortality, adjusting for between-group differences identified on univariate analysis.
  
  
  RESULTS
  Open AAA repair was performed in 3530 patients, using RP in 26% and TP in 74%. The RP group had a higher rate of suprarenal aortic clamp (60.9% vs 30.2%; P < .001), higher proportion of high-risk patients as stratified by the Vascular Study Group of New England Cardiac Risk Index (25.6% vs 22.2%; P = .038), and lower rate of iliac aneurysms (18.0% vs 31.2%; P < .001). After multivariable analysis, RP was associated with a lower incidence of cardiac events (12.2% vs 16.0%; adjusted odds ratio, 0.60; 95% confidence interval, 0.41-0.88; P = .009) and renal dysfunction (13.3% vs 16.5%; adjusted odds ratio, 0.65; 95% confidence interval, 0.46-0.97; P = .011). No difference in respiratory complications or mortality was identified.
  
  
  CONCLUSIONS
  Despite increased utilization of suprarenal aortic clamp during elective open AAA repair, the RP technique was associated with a lower risk-adjusted incidence of cardiac and renal complications compared with the TP technique.
authors.affiliation: Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, Tex.
authors.forename: Pedro G R
authors.initials: PG
authors.lastname: Teixeira
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of California Los Angeles, Los Angeles, Calif.
authors.forename: Karen
authors.initials: K
authors.lastname: Woo
authors.affiliation: Division of Vascular Surgery, Loma Linda Medical Center, Loma Linda, Calif.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Abou-Zamzam
authors.affiliation: Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.
authors.forename: Sara L
authors.initials: SL
authors.lastname: Zettervall
authors.affiliation: Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.
authors.forename: Marc L
authors.initials: ML
authors.lastname: Schermerhorn
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Southern California, Los Angeles, Calif. Electronic address: fweaver@med.usc.edu.
authors.forename: Fred A
authors.initials: FA
authors.lastname: Weaver
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D003250:Constriction; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D005260:Female; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D012187:Retroperitoneal Space / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality