Combining anatomic and physiologic scores can best predict patient's outcomes after EVAR
Emilia Krol1, Juliet Blakeslee - Carter1, David J. Dexter1, Jean Panneton2.
1EVMS, Norfolk, VA, USA, 2Jean Panneton, Norfolk, VA, USA.
OBJECTIVES: The American College of Surgeons National Surgical Quality Improvement Program Surgical risk Calculator (NSQIP) is an online tool available for determining 30-day complication risk for wide variety of procedures. Aortic Grading Score (AGS) is a system predicting technical difficulty and aortic related complications(ARC). Combination of physiologic and anatomic score is needed to predict long term outcomes and operative planning. METHODS: We performed a retrospective review of patients who underwent endovascular aneurysm repair (EVAR) between 2007 and 2011. Pre-operative CT scans were evaluated by a 3D imaging and previously calculated AGS score was used. NSQIP was calculated for every patient using the online calculator. Statistical analysis was performed using SPSS
RESULTS: We identified 89 patients who underwent EVAR. The 30-day systemic complication rate was 12% for the whole cohort. A total of 45 patients (50%) required aortic reintervention(AR). Patients in high ASG group (ASG≥14) had significantly higher rate of AR (N=61%) than patients in low ASG group (N=26%) (p<0.5). There was no significant difference between length of stay, 30-day systemic complications (SC), 30-day return to OR, and 30-day mortality. Higher ASG scores were not associated with higher NSQIP scores.We divided the cohort into three groups based on NSQIP averages; below average (57%), average (23%), and above average (19%) risk of complication. There was a significantly higher rate of 30-day systemic complications in the above average group (29%) compared to the average (24%) and below average (2%). There was no significant difference between any other variables. Higher NSQIP scores were not associated with higher ASG score.We combined the ASG and NSQIP into a single predictive score. Higher scores were significantly associated with higher rates of 30-day SR and AR, but the combined score was not superior to individual components. CONCLUSIONS: There remains a need for combined physiologic and anatomic score, that would help guide operative planning and predict outcomes in vascular patients. Combining two known, validated models (ASG and NISQIP) does not help predict long term outcomes or guide operative planning in vascular patients
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