The Impact Of Functional Status On Outcomes After Open Abdominal Aortic Aneurysm Repair
Abhishek Devaguptapu Rao, BA/BS, Ambar Mehta, MD, MPH, Virendra Patel, MD, MPH.
Columbia University, New York, NY, USA.
Introduction: The functional status of patients is increasingly used as a clinical decision-making factor when evaluating the status of patients prior to large elective surgery. We performed a national retrospective study of prospectively collected data from the Vascular Quality Initiative (VQI) to analyze the effect of functional status on open abdominal aortic aneurysm (AAA) repair. Methods: We identified all patients who underwent elective open AAA repairs from 2004-2009 in the VQI registry. We dichotomized patients by functional status into those that could independently ambulate versus those who could not. The demographic variables collected included age, gender, race, insurance status, BMI, prior aortic surgery, and former smoking status. The collected operative variables included approach used, operative renal ischemia time, proximal clamp site, and presence of iliac aneurysm. Outcomes included 30-day mortality, 30-day complications, failure to rescue (defined as death after a complication), and one-year all-cause mortality. We used both bivariate analyses and either multivariable logistic regressions or cox-proportional hazards modeling to adjust for case-mix and appropriate factors when evaluating all four outcomes. Results: Of 5374 patients identified, 93.8% (n=5043) had functional mobility and 6.2% (n= 331) had non-functional mobility. Patients with non-functional status tended to be older and female, with higher rates of co-morbidities and higher likelihood of being on Medicare or Medicaid. Univariate analysis showed increased rates of all adverse outcomes in patients with non-functional status. Adjusted analysis showed that non-functional status significantly increased odds of complications by 44% (OR 1.44 [95%-CI 1.10-1.89]) and one-year mortality by 49% (OR 1.49 [95%-CI 1.09-2.03]), but not failure to rescue (OR 1.04 [95%-CI .67-1.61]) or 30-day mortality (OR 1.21 [95%-CI 0.81-1.80]). Lower hospital volume, older age, and longer operative renal ischemia time were independently associated with adverse outcomes. Conclusions: A minority of patients undergoing open surgical repair of AAA cannot independently ambulate. Non-functional status is associated with decreased rates of long-term survival and increased peri-operative complications, potentially hinting at the lower physiological reserve with diminished functional status. Functional status serves a significant role in the initial pre-operative screening of patients being considered for open surgical repair of AAA.
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