The Impact Of Preoperative Pulmonary Status On Open Abdominal Aortic Aneurysm Repairs
Ambar Mehta, MD, MPH1, Priya Patel, M.D.1, Danielle Bajakian1, Nicholas Morrissey, M.D.1, Karan Garg, M.D.2, Jeffrey Siracuse3, James Iannuzzi, M.D.4, Marc Schermerhorn, M.D.5, Hiroo Takayama, M.D.1, Virendra Patel, M.D.1.
1Columbia University Medical Center, New York, NY, USA, 2NYU Langone Vascular & Endovascular Surgery, NYU Langone Vascular & Endovascular Surgery, NY, USA, 3Boston University Department of Vascular Surgery, Boston, MA, USA, 4UCSF Department of Vascular Surgery, San Francisco, CA, USA, 5Beth Israel Deaconess Department of Vascular Surgery, Boston, MA, USA.
OBJECTIVES: While endovascular repairs of abdominal aortic aneurysms (AAAs) can be performed under less-invasive modes of anesthesia, such as moderate sedation with local anesthesia, open repairs of AAAs all require general anesthesia. Accordingly, a patient’s underlying pulmonary function further impacts their postoperative outcomes. We evaluated the association between the extent of a patient’s COPD status and outcomes after open AAA repairs in a clinically-robust registry.
METHODS: We identified all patients undergoing open elective or urgent repairs of non-ruptured infrarenal and juxtarenal AAAs in the Vascular Quality Initiative registry from 2013 to 2019. We categorized COPD status into three groups: requiring no medications, requiring medications, and requiring supplemental oxygen. Primary outcomes included delayed extubation (≥24 hours after surgery) and postoperative pneumonia. Secondary outcomes included 30-day mortality and one-year mortality. Multivariable logistic regressions and cox-proportional hazards models evaluated these outcomes after accounting for patient demographics, preoperative medications, intraoperative factors (i.e., proximal clamp site, visceral or renal ischemia time, retroperitoneal versus transabdominal approach), and hospital volume.
RESULTS: We identified 6058 patients undergoing open AAA repairs (median age 70 years, 74% male, 5% African American). Half of all patients had infrarenal proximal clamp sites (51%), followed by clamp sites above a single renal artery (15%), supra-renal clamping (26%), and supra-celiac clamping (7.2%). One-third of all patients had COPD (33%), composed of 12% requiring no medications, 19% taking medications, and the remaining 2.2% on home supplemental oxygen. Rates of primary and secondary outcomes included: delayed extubation (11%), pneumonia (11%), 30-day mortality (4.4%), and one-year mortality (7.2%). After adjustment, there existed an increasing adverse association by underlying preoperative severity of COPD status (Table) among all four outcomes.
CONCLUSIONS: There exists a linear relationship between patient preoperative COPD status and outcomes among open AAA repairs. Specifically, patients with COPD who required medications had higher rates of prolonged extubation and pneumonia, and those on supplemental oxygen additional had higher rates of one-year mortality. We argue that patients requiring supplemental oxygen at baseline should undergo non-operative management unless strong indications for repair exist.
Back to 2022 ePosters