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The Majority Of Patients Who Survive A Ruptured Abdominal Aortic Aneurysm Are Able To Return To Home Living
Omar M. ElShazly, MD, Jeffrey J. Siracuse, MD, MBA, Alik Farber, MD, MBA, Elizabeth King, MD, Denis Rybin;
Boston University, Boston, MA, USA
Objective:Ruptured abdominal aortic aneurysm (rAAA) is a potential life-alerting event and is associated with significant morbidity and mortality. Patients that survive often require extension rehabilitation. Our goal was to assess for patients with rAAA that were able to return to living at home.
Methods: We analyzed the Vascular Quality Initiative open and endovascular AAA registry(2003-2022) focusing on rAAA. Only patients that preoperatively lived at home and survived their hospitalization and followed up were included. Long-term living at home was the primary outcome.
Results: There were 5137 that preoperatively lived at home and survived index hospitalization, of which 2822 had a recorded follow-up of at least 90 days. Average age was 71.2 and 79.9% were male sex. Repair type was open in 37.8% and endovascular repair in 62.2%. More than half of open repairs were infrarenal clamps (53.7%). The majority of this cohort had a postoperative complication (78.4%) including 20% cardiac, 20.3% pulmonary, 1.8% stroke, 36.7% renal, 3.9% leg ischemia, and 8.2% bowel ischemia. Initial home discharge was in 62.6%. There were 13% that died before follow-up. Of those that returned for follow-up, 96% were living at home. Multivariable analysis for not returning to home living showed that post-operative pulmonary complications (OR 3.15, 95% CI 1.99-4.99, P<0.001), female sex (OR 3.13, 95% CI 2-4.89, P<0.001), preoperative cardiac arrest 2.21 (OR 2.21, 95% CI 1.04-4.72, P=.04), and age (per year) (OR 1.06, 95% CI 1.035-1.09, P<0.001) are associated with non-returning to home.
Conclusion: The majority of patients that survived the perioperative period after rAAA were able to return to living at home. Older age, female sex, and peri-procedure cardiovascular complications were associated with not returning home. A significant number of patients did not have long-term follow-up after rAAA and represent an area for practice improvement.
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