Impact of Declining Institutional Memory on Adverse Events following Open Abdominal Aortic Aneurysm Repair
Anna Kinio1, Tim Ramsay, PhD2, Prasad Jetty, MD, FRCSC3, Nagpal Sudhir, MD, FRCSC3.
1University of Ottawa, Ottawa, ON, Canada, 2Ottawa Hospital Research Institute, Ottawa, ON, Canada, 3The Ottawa Hospital, Ottawa, ON, Canada.
Since its introduction 20 years ago, endovascular aortic aneurysm repair (EVAR) has become a mainstay in the treatment of aneurysms, resulting in the decline of open aneurysmal repairs (OAR). However, high quality OAR remains relevant to aneurysm treatment. We hypothesize that the decrease in OAR frequency has led to a decline in institutional memory and an increase in post-surgical complications and perioperative efficiency.
A retrospective cohort study compared perioperative data and complications of 30 consecutive juxtarenal (<1 cm neck) OAR surgeries performed between 2015-2017 and 53 consecutive juxtarenal controls (2005-2007) at The Ottawa Hospital, a tertiary level teaching institution. There was no change in surgical personnel during this 10 year comparison.
20.0 % of patients in the 2015-2017 group experienced post-surgical complications of Clavien Dindo Grade IIIa or higher, compared to 11.3% of patients in the historical control group (p = 0.337). However, 86.2 % of patients from 2015-2017 experienced deviations from the normal post-operative course, compared to 64.4% of patients in the control group (p = 0.051). Length of ICU stay, hospital stay, and mortality rate were not significantly different between the groups. Total OR time for the 2015-2017 group was significantly increased to 338 minutes compared to the control group (300 minutes, p = 0.038). Interestingly, surgery and anesthesia times were not significantly different, although anesthesia time trended towards significance, with an increase in the 2015-2017 anesthesia time (87.3 vs 78.8 minutes, p = 0.074).
30 juxtarenal OARs were performed in TOH from 2015-2017, approximately half the number performed during the control time period a decade earlier. Complication rates and overall OR time were increased compared to the historical control group. These findings may reflect a decreased institutional familiarity with open aneurysm repairs and post-surgical care. Implications for declining open abdominal aortic repair results require further study.
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