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OBJECTIVES: National data evaluating outcomes for occlusive abdominal aortic reconstructions are well described. The relative effect of operative indication, as well as the presence of concomitant AAA on in-hospital mortality is not well defined.
METHODS: The Nationwide Inpatient Sample (NIS) was queried to identify patients who underwent open aortic surgery (2003-2010). Indication for surgery was classified by ICD-9 diagnostic codes to identify isolated occlusive indications as well as combined occlusive disease and AAA. Primary outcome was in-hospital mortality. Secondary outcomes were complications and discharge disposition.
RESULTS: Overall, 56,374 underwent aortic reconstruction, 48,591 for occlusive disease (86.2%) and 7783 for combined occlusive disease with AAA (13.8%). Intermittent Claudication (IC) was the most common indication for intervention (60.9%) while 39.7% underwent intervention for CLI (22.2% rest pain, 17.6% gangrene). ICs had more concomitant AAA (17.3%), than did CLIs (8.4%). The baseline characteristics for those with occlusive disease and combined occlusive with AAA disease were similar in terms of obesity (4.8% vs 4.2%, P=0.27) and CHF (6.6% vs 6.3%, P=0.65), but differed by age (62.2 yrs vs. 68.4 yrs, P<0.0001) and HTN (65.4% vs. 69.1%, P=0.005). Patients with combined occlusive and AAA disease had higher mortality than those with occlusive disease alone (3.9% vs. 2.7%, P=.01). Outcomes stratified by indication are shown in the table. On multivariable regression, factors associated with in-hospital mortality included gangrene with AAA compared to gangrene alone (2.8 [1.6, 4.7], P<0.0002), age > 65 years age (3.1 [2.4, 4.1], P<0.0001), renal failure (2.7 [1.9, 3.8], P<0.0001), and concurrent lower extremity revascularization (1.3 [1.1, 1.7], P<0.02).
CONCLUSIONS: IC or CLI with concomitant AAA carries a higher mortality than IC or CLI alone, especially in older patients with gangrene requiring revascularization and renal insufficiency. Preoperative risk stratification strategies should focus on the indication for surgery as well as the presence of concomitant AAA.

In-hospital Mortality Following Aortic Surgery for Occlusive Indications ± Concomitant AAA

Variable	Claudication N=34,357 (60.9%)			Rest Pain N=12,514 (22.2%)			Gangrene N=9896 (17.6%)
	Isolated N=28,423	AAA N=5934	P value	Isolated N=11,414	AAA N=1100	P value	Isolated N=9109	AAA N=787	P value
Mortality	1.9%	2.7%	0.0048*	2.4%	4.2%	0.14	5.6%	13.2%	0.0001*
LOS, Days	7.3 ± 0.1	8.0 ± 0.2	<0.0001*	8.4 ± 0.2	9.3 ± 0.5	<0.0001*	14.6 ± 0.4	16.4 ± 1.2	0.16
Discharge to Facility	8.6%	15.5%	<0.0001*	12.5%	22.2%	<0.0001*	38.8%	47.1%	0.05*
Tracheostomy	0.6%	0.2%	0.11	0.6%	1.9%	0.03*	1.3%	4.9%	0.0004*