Dependent Functional Status Does Not Predict Poor Outcomes for Patients undergoing Repair of Ruptured Abdominal Aortic Aneursyms
Arjun Agrawal, Rachael Snow, MA, Erik Lehman, Faisal Aziz, MD, FACS.
Penn State Uniersity, Hershey, PA, USA.
Objectives
Despite advances in surgical technique, ruptured AAA (rAAA) remains associated with high mortality. A preoperative dependent functional status has previously been shown to be associated with poor outcomes after vascular surgery procedures. The purpose of this study is to examine the effect of preoperative functional status on postoperative outcomes for patients undergoing repair of ruptured abdominal aortic aneurysms. Methods The 2012-2013 ACS-NSQIP database was used. Patient demographics, procedural data, and post-operative outcome data was analyzed. Two groups: dependent functional status and independent functional status. Outcomes and demographics were compared between these two groups. A multivariate logistic regression analysis was then conducted to assess independent risk factors that predispose to dependent functional status.Results Total number of patients: 1205 (M 77%, F 23%). Two groups were created, preoperative dependent functional status (5%), and independent functional status (95%). Outcomes: superficial surgical site infections (OR 0.64, p=0.69), organ/space surgical site infections (OR 0.97, p=0.98) wound disruptions (OR 0.73, p=0.76), post-operative pneumonia (OR 0.96, p=0.92), ventilator dependence (OR 1.34, p=0.29), acute renal failure (OR 1.37, p=0.61), urinary tract infection (OR 0.78, p=0.73), excessive bleeding (OR 0.96, p=0.76), cardiac arrest (OR 1.03, p=0.943), myocardial infarction (OR 0.83, p=0.76), DVT (OR 0.66, p=0.57), return to OR (OR 0.91, p=0.78), unplanned reoperation (OR 0.91, p=0.78), unplanned readmission (OR 1.69, P=0.21), or stroke/CVA (OR 2.59, p=0.13). Interestingly, there was found to be an increased risk of septic shock postoperatively (OR 2.56, P=0.01) for patients with dependent functional status, as well as a slightly increased association with mortality (OR 2.13, p=0.04). A risk prediction model for determining the dependent functional status was then developed (Table I). Conclusions Dependent functional status has no effect on the outcomes of operations for rAAA and that preoperative dialysis is a strong predictor of dependent functional status. Dependent functional status should not exclude patients from being offered surgical treatment.
| Age 60-69 | Age 70-79 | Age >=80 | Female Gender | Dyspnea | HTN | Dialysis | Shock | Probability |
| + | - | - | - | - | - | - | - | 0.54 |
| - | - | - | - | - | - | - | + | 0.83 |
| - | - | - | - | - | + | - | - | 0.87 |
| - | - | - | + | - | - | - | - | 0.96 |
| - | - | - | - | + | - | - | - | 1.30 |
| - | + | - | - | - | - | - | - | 1.58 |
| - | - | + | - | - | - | - | - | 2.23 |
| - | - | - | - | - | - | + | - | 2.95 |
| - | - | + | + | + | + | + | + | 90.05 |
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