Impact Of Chronic Kidney Disease On Peri-operative Mortality After Complex Abdominal Aortic Aneurysm Repair
Jennifer Li, MD1, Jennifer Li, MD1, Livia E.v.m. de Guerre, MD2, Patric Liang, MD1, Marc Schermerhorn, MD1.
1Beth Israel Deaconess Medical Center, Boston, MA, USA, 2University Medical Center, Utrecht, Netherlands.
Objectives: Pre-operative chronic kidney disease (CKD) is associated with worse outcomes after abdominal aortic aneurysm (AAA) repair. However, between complex open versus endovascular AAA repair, the impact of CKD on peri-operative mortality has yet to be defined. Here we compare outcomes between strata of CKD severity after open and endovascular treatment of complex AAA.
Methods: We identified all patients who underwent complex AAA repair between 2011 and 2017 in the American College of Surgeons National Surgical Quality Improvement Program targeted vascular module. Complex repairs were defined as those for juxtarenal, pararenal, or suprarenal aneurysms. We utilize multivariate logistic regression stratified by CKD severity (GFR<30, 30-60, >60) to model 30-day perioperative mortality between complex open and endovascular repair (EVAR).
Results: We identified 2,699 complex AAA repairs, of which 1500 were open and 1199 were EVARs. The distribution of CKD severity in the complex open cohort were as follows: 5.1% GFR<30, 29.2% GFR 30-60, 65.7% GFR >60; in the complex EVAR cohort: 6.7% GFR<30, 32.5% GFR 30-60, 60.9% GFR >60. Comparing all complex EVAR to complex open using multivariate logistic regression controlling for age, gender, diabetes, smoking status, hypertension, COPD, and CHF, there was a 30-day mortality odds ratio of 0.30 (95% CI 0.23 – 0.39, p <0.001). For all complex repairs as compared to GFR >60, GFR of <30 confers 4.91 OR (95% CI 3.40 – 7.11, p <0.001) and a GFR of 30-60 confers 2.37 OR (95% CI 1.83 – 3.08, p <0.001) of 30-day mortality. Within the complex open repair cohort, a GFR of <30 confers 4.46 OR (95% CI 2.94 – 6.76, p <0.001) and a GFR of 30-60 confers 2.59 OR (95% CI 1.95 – 3.44, p <0.001) of 30-day mortality. Within the complex EVAR cohort, a GFR of <30 confers 5.17 OR (95% CI 3.20 – 8.34, p <0.001) and a GFR of 30-60 confers 2.29 OR (95% CI 1.60 – 3.28, p <0.001) of 30-day mortality.
Conclusions: Pre-operative CKD is a significant independent predictor of peri-operative mortality in both open and EVAR complex AAA cohorts, with greater effect in the EVAR cohort. Further studies are warranted to determine how CKD severity may serve in risk stratification and patient selection.
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