Back to 2024 Display Posters
Hemodynamic Instability Predicts Morbidity And Mortality In Patients Undergoing Open And Endovascular Abdominal Aneurysm Repair
Nadin S. Elsayed, MD1, Asma Mathlouthi, MD
2, Mahmoud Malas, MD MHS
1, Andrew Barleben, MD
1.
1University of California San Diego, san diego, CA, USA,
2Oregon Health & Science University, Portland, OR, USA.
OBJECTIVES: Hemodynamic condition of ruptured abdominal aortic aneurysm (rAAA) is an important prognostic factor for operative outcomes. Nonetheless, the impact of the hemodynamic status of rAAA patients on outcomes of open aneurysm repair (OAR) or endovascular aneurysm repair (EVAR) has not been addressed appropriately. We aim to compare in-hospital outcomes for unstable vs stable patients undergoing OAR or EVAR.
METHODS: All patients undergoing OAR or EVAR for rAAA in the VQI database from 2003 to 2022 were included. We compared outcomes of unstable vs stable rAAA patients stratified by the type of the procedure (OAR or EVAR). Hemodynamic instability was defined as preoperative systemic blood pressure <90 mm Hg.
RESULTS: OAR cohort included 2,787 patients (1,161 stable and 1,626 unstable) and the EVAR cohort included 4,432 patients (2,195 stable and 2,237 unstable). Hemodynamically unstable patients undergoing OAR or EVAR were more likely to be disoriented or unconscious on presentation. Among OAR patients, hemodynamic instability was associated with 92% increase in mortality, 2 times higher odds of blood transfusion, 49% increase in respiratory complications, 55% higher odds of bowel ischemia, 73% higher odds of stroke, 71% higher odds of leg ischemia, and 45% increased odds of non-home discharge (Table 1). Among EVAR patients, hemodynamic instability was associated with 2.5 times higher odds of mortality, 3.7 times higher odds of blood transfusion, 95% increase in respiratory complications, 2 times increased risk of bowel ischemia, 51% higher odds of leg ischemia, and 75% increased odds of non-home discharge (Table 2).
CONCLUSIONS: To date, this is the first study to show outcomes of unstable vs stable rAAA patients. We found that hemodynamic instability is associated with significantly higher odds of in-hospital mortality and morbidity regardless of the procedure type. Future studies are needed to investigate the underlying factors of these worse outcomes.
Table 1. Unstable vs stable rAAA outcomes in OAR patients | Univariate | | | MultivariateUnstable vs stable | |
| Stable | Unstable | P VALUE | aOR (95%CI) | P VALUE |
| Mortality | 280 (24.12) | 725 (44.59) | <0.001 | 1.92 (1.54-2.39) | <0.001 |
| Packed RBCs transfusion | 962 (83.22) | 1,507 (94.01) | <0.001 | 2.24 (1.59-3.16) | <0.001 |
| Respiratory complications | 333 (29.39) | 600 (40.57) | <0.001 | 1.49 (1.24-1.80) | <0.001 |
| Bowel ischemia | 141 (12.46) | 309 (20.96) | <0.001 | 1.55 (1.19-2.02) | <0.001 |
| Stroke | 22 (2.10) | 57 (4.29) | 0.003 | 1.73 (1.09-2.74) | 0.021 |
| Leg ischemia | 72 (6.35) | 151 (10.22) | <0.001 | 1.71 (1.27-2.29) | <0.001 |
| Non-home discharge | 390 (44.27) | 514 (56.92) | <0.001 | 1.45 (1.17-1.79) | <0.001 |
Table 2. Unstable vs stable rAAA outcomes in EVAR patients | Univariate | | | MultivariateUnstable vs stable | |
| Stable | Unstable | P VALUE | aOR (95%CI) | P VALUE |
| Mortality | 253 (11.53) | 700 (31.29) | <0.001 | 2.57 (2.13-3.11) | <0.001 |
| Packed RBCs transfusion | 1,143 (52.92) | 1,818 (83.28) | <0.001 | 3.74 (3.16-4.43) | <0.001 |
| Respiratory complications | 259 (11.95) | 492 (22.53) | <0.001 | 1.95 (1.62-2.33) | <0.001 |
| Bowel ischemia | 78 (3.60) | 188 (8.62) | <0.001 | 2.07 (1.53-2.79) | <0.001 |
| Stroke | 36 (1.68) | 63 (2.92) | 0.007 | 1.40 (0.84-2.35) | 0.201 |
| Leg ischemia | 58 (2.68) | 84 (3.85) | 0.029 | 1.51 (1.03-2.22) | 0.034 |
| Non-home discharge | 492 (25.27) | 614 (39.79) | <0.001 | 1.75 (1.47-2.09) | <0.001 |
Back to 2024 Display Posters
