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Predictors of Renal Complication following Endovascular and Open Repair of Infra-renal Aortic Aneurysm
Sara L. Zettervall, MD, Klaas HJ Ultee, MD, Peter A. Soden, MD, Sarah E. Deery, MD, Katie E. Shean, MD, Marc L. Schermerhorn, MD.
Beth Israel Deaconess Medical Center, Boston, MA, USA.
OBJECTIVES:
Renal complications following repair of abdominal aortic aneurysms (AAA) have been associated with increased morbidity and mortality. However, limited data are available to identify risk factors for renal complications. This study aims to identify predictors of renal complications following endovascular (EVAR) and open repair.
METHODS:
Patients who underwent EVAR or open repair of a non-ruptured infrarenal AAA between 2011 and 2013 were identified in the Targeted Vascular module of the American College of Surgeons National Surgical Quality Improvement Project. Renal complications were defined as new postoperative dialysis or creatinine increase greater than 2mg/dL. Patients on hemodialysis preoperatively were excluded. Patient characteristics, operative details, and outcomes were compared using univariate analysis between those with and without renal complications. Multivariable logistic regression was utilized to identify independent predictors of renal complications.
RESULTS:
4503 patients underwent elective repair of infrarenal AAA (14% open and 86% EVAR). Renal complication occurred in 1% of patients following EVAR and 5% of patients following open repair. 30-day mortality was significantly greater among patients with renal complications (EVAR: 55% vs 1% P < .01; Open: 30% vs 4% P < .01). Other adverse outcomes including: postoperative myocardial infarction, pulmonary complications, ischemic colitis, and prolonged length of stay were also more common among patients with renal complications (Table 1). In multivariable analysis a preoperative creatinine greater than 1.4 (OR 7.2, 95% CI 4.2-12.3), perioperative transfusion (OR 5.0 95% CI 2.6-9.8), prolonged operative time (OR 4.0 95% CI 2.3-7.2), and open repair (OR: 3.2 95% CI 1.7-6.2) were associated with increased risk of renal complication.
CONCLUSIONS:
Increased preoperative creatinine, perioperative transfusion, and open technique are independent predictors of renal complications following infrarenal AAA repair. Given the strong association between postoperative renal failure and adverse outcomes, especially mortality, these predictors should play an important role in preoperative risk stratification and postoperative management.
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