Chronic Obstructive Pulmonary Disease Severity Effect On Outcomes Following Endovascular Aortic Aneurysm Repair
Priya Patel, MD MPH, Ambar Mehta, MD, Abhishek Rao, Nicolas Morrissey, MD, Danielle Bajakian, MD MPH, Jeffrey Siracuse, MD, Karan Garg, MD, Samuel Schwartz, MD, Marc L. Schermerhorn, M, Hiroo Takayama, MD PhD, Virendra I. Patel, MD MPH.
Columbia University Medical Center, New York City, NY, USA.
OBJECTIVES: EVAR in patients with chronic obstructive pulmonary disease (COPD) has been associated with improved outcomes compared with open repair. However, the effect of COPD severity on outcomes following endovascular repair are not well defined. Therefore, we examined the effect of COPD severity - not medically treated, medically treated, and on supplementary home oxygen - on outcomes following EVAR. METHODS: We identified all elective infrarenal EVARs within the VQI registry between 2011-2020. Primary outcome was post-operative mortality. Secondary outcomes were reintubation, delayed extubation (>24 hours after repair), and 5-year mortality. Logistic regression and cox regression models were utilized to identify the independent effect of COPD severity on outcomes of interest.
RESULTS: Among 46335 patients who underwent infrarenal EVAR, 33% had COPD. Of the patients with COPD, 28% were not medically treated, 57% were medical treated, and 15% were on supplemental home oxygen. Multivariable analysis demonstrated increasing COPD severity was associated with higher odds of adverse outcomes following repair. COPD that was not medically treated was associated with higher odds of postoperative mortality (OR: 1.3; 95%CI[1.1-1.6]), reintubation (OR 1.7[1.3-2.0]), and delayed extubation (OR 1.3[1.1-1.7]). COPD that was medically managed was associated with higher odds of reintubation (OR 1.4[1.2-1.6]), but not postoperative mortality (OR 1.1[.95-1.3]), or delayed extubation (OR .98[.81-1.2]). COPD with supplement home oxygen was associated with higher odds of postoperative mortality (OR 1.9[1.6-2.4]), reintubation (OR 2.7[2.1-3.3]), and delayed extubation (OR 1.6[1.5-2.5]). Five-year mortality was 14% for patients without COPD, 17% for patients not medically treated, 20% for patients medically managed, and 30% for patients on supplemental home oxygen therapy (log rank P-value <.001). (Figure) COPD severity was independently associated with higher 5-year mortality (No treatment: aHR 1.6[1.3-1.9]; Medically managed: aHR 1.5[1.3-1.7]; Home oxygen: aHR 2.2[1.7-2.7]). CONCLUSIONS: COPD is associated with increased perioperative mortality and respiratory complications as well as late mortality following EVAR. While endovascular repair may offer improved outcomes compared to open repair, preoperative medical optimization of patients with COPD may improve postoperative outcomes following repair. Postoperative and long-term outcomes following repair in this patient population should be factored into pre-operative clinical decision making. 
Back to 2022 ePosters