title: Functional status predicts major complications and death after endovascular repair of abdominal aortic aneurysms.
abstract: Endovascular aneurysm repair (EVAR) is considered a lower risk option for treating abdominal aortic aneurysms and is of particular utility in patients with poor functional status who may be poor candidates for open repair. However, the specific contribution of preoperative functional status to EVAR outcomes remains poorly defined. We hypothesized that impaired functional status, based simply on the ability of patients to perform activities of daily living, is associated with worse outcomes after EVAR.
  
  
  
  Patients undergoing nonemergent EVAR for abdominal aortic aneurysm between 2010 and 2014 were identified in the National Surgical Quality Improvement Program (NSQIP) database. The primary outcomes were 30-day mortality and major operative and systemic complications. Secondary outcomes were inpatient length of stay, need for reoperation, and discharge disposition. Using the NSQIP-defined preoperative functional status, patients were stratified as independent or dependent (either partial or totally dependent) and compared by univariate and multivariable analyses.
  
  
  
  Of 13,432 patients undergoing EVAR between 2010 and 2014, 13,043 were independent (97%) and 389 were dependent (3%) before surgery. Dependent patients were older and more frequently minorities; had higher rates of chronic pulmonary, heart, and kidney disease; and were more likely to have an American Society of Anesthesiologists score of 4 or 5. On multivariable analysis, preoperative dependent status was an independent risk factor for operative complications (odds ratio [OR], 3.1; 95% confidence interval [CI], 2.5-3.9), systemic complications (OR, 2.8; 95% CI, 2.0-3.9), and 30-day mortality (OR, 3.4; 95% CI, 2.1-5.6). Secondary outcomes were worse among dependent patients.
  
  
  
  Although EVAR is a minimally invasive procedure with substantially less physiologic stress than in open aortic repair, preoperative functional status is a critical determinant of adverse outcomes after EVAR in spite of the minimally invasive nature of the procedure. Functional status, as measured by performance of activities of daily living, can be used as a valuable marker of increased perioperative risk and may identify patients who may benefit from preoperative conditioning and specialized perioperative care.
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md. Electronic address: dharris@smail.umaryland.edu.
authors.forename: Donald G
authors.initials: DG
authors.lastname: Harris
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Ilynn
authors.initials: I
authors.lastname: Bulatao
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Connor P
authors.initials: CP
authors.lastname: Oates
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Richa
authors.initials: R
authors.lastname: Kalsi
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Drucker
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Nandakumar
authors.initials: N
authors.lastname: Menon
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Tanya R
authors.initials: TR
authors.lastname: Flohr
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Center for Aortic Disease, University of Maryland Medical Center, Baltimore, Md.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Crawford
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006304:Health Status; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States