Early Reinterventions are More Frequent After Open Versus Endovascular Abdominal Aortic Aneurysm Repair
Sarah E. Deery, MD, Sara L. Zettervall, MD MPH, Katie E. Shean, MD, Peter A. Soden, MD, Thomas F.X. O'Donnell, Thomas C.F. Bodewes, MD, Alexander B. Pothof, MD, Marc L. Schermerhorn, MD.
Beth Israel Deaconess Medical Center, Boston, MA, USA.
OBJECTIVES: Reinterventions are generally considered to be more common after EVAR than open repair, although little is known about reinterventions in the early postoperative period. Furthermore, there are few data regarding the impact of early reintervention on 30-day mortality. We sought to evaluate the rates and types of reintervention following AAA repair and the impact of reintervention on postoperative mortality. METHODS: The ACS-NSQIP was queried from 2012-2014 for all intact, infrarenal AAA repairs. Thirty-day reinterventions were identified by CPT codes. Univariate analysis comparing patients with and without reinterventions was performed with the Fisher Exact test and Mann-Whitney test. Logistic regression was used to identify predictors of reinterventions and to assess the association between 30-day reintervention and mortality. RESULTS: 5,980 patients were identified [Open: 715 (12%), EVAR: 5,265 (88%)] of whom 271 (Open 7.8% vs. EVAR 4.1%, P < .001) underwent reintervention. Patients who underwent reinterventions had larger aortic diameter (median 5.7 cm vs. 5.5 cm, P < .01), were more likely symptomatic on presentation (18% vs. 10%, P < .001), and more likely had renal insufficiency (7.8% vs. 3.6%, P < .01) and prior abdominal operations (32% vs. 26%, P = .03). Patients who underwent reintervention had higher 30-day mortality (Open: 23% vs. 3.2%, P < .001; EVAR: 13% vs. 1.0%, P < .001) and major complications. Significant predictors of reintervention following open repair included non-white race; predictors after EVAR included diameter, symptom status, renal insufficiency, and prior abdominal surgery. After adjusting for demographics and comorbidities, reintervention was a significant predictor of 30-day mortality after open repair (Odds Ratio 15, 95% Confidence Interval: 5.3-42.6, P < .001) and EVAR (12.5, 6.8-22.8, P < .001). CONCLUSIONS:
Patients undergoing open AAA repair compared to EVAR were significantly more likely to undergo early reintervention. Reinterventions after both EVAR and open repair were associated with an over 10-fold increase in post-operative mortality, emphasizing the need to minimize the necessity of reintervention.
| No (%) | Open: 715 (12) | EVAR: 5,265 (88) | P-Value |
| Reinterventions (any) | 56 (7.8) | 215 (4.1) | <.001 |
| Vascular (any) | 12 (1.7) | 102 (1.9) | .77 |
| Endovascular | 4 (0.6) | 30 (0.6) | 1 |
| Aneurysm-related, Endovascular | 0 (0) | 9 (0.2) | .61 |
| Open Vascular | 11 (1.5) | 72 (1.4) | .73 |
| Aneurysm-related, Open | 0 (0) | 5 (0.1) | 1 |
| Pulmonary | 4 (0.6) | 6 (0.1) | .02 |
| Major Abdominal | 22 (3.1) | 28 (0.5) | <.001 |
| Bleeding-related | 10 (1.4) | 17 (0.3) | .001 |
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