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Risks Associated with Modern Open Aortic Surgery: Abdominal Aortic Aneurysm Patients Have A Higher Rate of Postoperative Complications than Aortic Occlusive Disease Patients
Qinghua Pu, MD, Atul Rao, MD, Alexander Shiferson, DO, Michael Shih, MD, Muhammad A. Khan, MD, Suttatip Vechvitvarakul, MD, Robert Rhee, MD.
Maimonides Medical Center, Brooklyn, NY, USA.
OBJECTIVE: Open elective abdominal aortic surgery remains a relatively high-risk procedure in the modern era compared to endovascular therapies. The decision process to proceed with a non-endovascular option may be somewhat different for patients with abdominal aortic aneurysm (AAA) disease versus patients with aortoiliac occlusive disease (AIOD). The goal of this study is to compare these two groups of patients with open aortic surgery in the modern endovascular era with regard to risk factors, postoperative morbidity and mortality.
METHODS: Patients that underwent AAA and AOD open aortic surgery in the National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2011 were identified through a combination of procedure and diagnosis codes. Propensity score analysis was performed to age-match both groups. Preoperative risk factors and 30-day outcomes of surgery were compared between two groups using the t-test or Chi-square test.
RESULTS: A total of 5780 patients were identified during the study period; AAA (n = 4639), AIOD (n = 1141). The average age of AAA patients was 9.1 years older than AIOD patients (p<0.001). After age-matching, the AIOD-group were found to have significantly higher prevalence of insulin-treated diabetes, smoking and severe PVD. In contrast, more AAA patients had history of cardiac surgery, while there was no differences in ischemic heart disease. The AAA-group had shorter duration of surgery, but the requirement for blood transfusion was similar. Postoperatively, more AAA patients had acute renal failure (3.5% vs 2.0%, p<0.05), urinary tract infection (4.3% vs 2.4%, p<0.01) and ventilation>48 hours (10.4% vs 7.8%, p<0.05). The AIOD-group had more surgical site infection (6.1% vs 2.2%, p<0.001), graft failure (2.7% vs 0.5%, p<0.001) and returning to OR (13.5% vs 8.1%, p<0.001). No difference was found in hospital length of stay, 30-day mortality, myocardial infarction or stroke.
CONCLUSION: AAA and AIOD patients are demographically different. With adjusted age, patients with AAA are at higher risk of developing
postoperative organ dysfunction than patients with occlusive disease, despite no significant differences in hospital length of stay or 30-day mortality. Patients selected for open AAA surgery should be considered for a more thorough preoperative investigation to minimize post-operative organ dysfunction. Special attention should be focused on reducing the high rate of pulmonary complications in both groups.
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