Society For Clinical Vascular Surgery

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Factors Associated with In-Hospital Complications and Effect of Complications on Long-Term Survival Following EVAR in Elderly Patients
Rens R,B. Varkevisser, BS1, Thomas F.X. O'Donell, MD1, Nicholas J. Swerdlow, MD1, Patric Liang, MD1, Virendra I. Patel, MD2, Salvatore T. Scali, MD3, Hence J.M. Verhagen, MD, PhD4, Marc L. Schermerhorn, MD1.
1Beth Israel Deaconess Medical Center, Boston, MA, USA, 2New York Presbyterian Hospital, New York, NY, USA, 3University of Florida Health, Gainesville, FL, USA, 4Erasmus University Medical Center, Rotterdam, Netherlands.

OBJECTIVES: Perioperative complications in elderly patients undergoing EVAR occur more frequently compared to mortality events. While perioperative mortality has been well described in the elderly patient population, factors associated with in-hospital complications and their impact on long-term survival remain poorly characterized.
METHODS: We identified all patients undergoing EVAR for non-ruptured infrarenal AAA within the Vascular Quality Initiative registry (2003-2018) and compared in-hospital complication rates between elderly (age ≥75) and non-elderly patients (<75). We used multivariable logistic regression to identify factors associated with in-hospital complications. Kaplan-Meier analysis and Cox proportional-hazards models were then used to determine associations between in-hospital complications and long-term survival in elderly patients. To assess the effect of complications on both early, mid-term, and late survival, we stratified survival periods into the first 30 days after discharge, and between months 1-6, 7-12, and years 1-8 after index procedure. Knaus-Wagner chi-pie analyses were used to assess the relative contribution of individual complications on 0-8-year survival.
RESULTS: A total of 15,517 elderly patients and 18,253 non-elderly patients were identified. Elderly patients experienced higher complication rates compared to non-elderly patients (19% vs 12%, P<.001). Factors associated with in-hospital complications are presented in the figure. Patients with any complication had lower unadjusted Kaplan-Meier survival estimates compared to patients without complications at one (82 vs. 95%, P<.001), five (67 vs. 82%, P<.001), and eight years (61 vs. 73%, P<.001). After risk-adjustment, in-hospital complications were independently associated with higher mortality at all time points, although the association attenuated over time (first month post-discharge: HR 3.9 [2.7-5.6], P<.001; 1-6 months post-procedure: HR 2.1 [1.7-2.5], P<.001; 7-12 months post-procedure: HR 1.3 [1.0-1.6], P=.024; 1-8 years post-procedure: HR 1.2 [1.0-1.3], P=.017). In-hospital complications accounted for 27% of the variation in survival between index procedure and 8-years, of which reintubation (38%), creatinine increase (17%), new dialysis (14%), and myocardial infarction (10%) contributed most significantly to poor long-term survival.
CONCLUSIONS: Elderly patients are at higher risk for in-hospital complications following EVAR. These in-hospital complications have a significant impact on survival, especially in the early post-discharge period, but this effect also extends to long-term survival. survival.


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