Long-Term Postoperative Outcomes after Abdominal Aortic Aneurysm Repair
Rteil A, Weaver MR, Shepard AD, Nypaver TJ, Lee A, and Kabbani LS. Long-Term Postoperative Outcomes after Abdominal Aortic Aneurysm Repair. Journal of the American College of Surgeons 2020; 231(4):e264-e265.
Journal of the American College of Surgeons
Introduction: Open surgical repair remains the standard of care for Juxtarenal, suprarenal, and Type-IV Thoracoabominal aortic aneurysms (TAAA). In this study, we reviewed our experience with open surgical Abdominal Aortic Aneurysm (AAA) repair and long-term patient outcomes. Methods: We conducted a retrospective chart review on all patients who underwent open abdominal aortic aneurysm repair between the years 1986 and 2017 at our tertiary care center. Aneurysms were classified as Infrarenal (IR), Suprarenal (SR), Juxtarenal (JR), and Type-IV TAAA. Demographics, co-morbidities, preoperative/postoperative lab values, and patient outcomes were collected. Surgical variables such as operative time, estimated blood loss (EBL), and transfusion requirements were recorded. Multiple comparisons were performed using pairwise chi-square tests or Fisher’s exact tests, adjusted with a Bonferroni p-value correction. Results: There were 165 JR-AAA, 81 SR-AAA, 55 Type-IV TAAA, and 318 IR-AAA open repairs on record between 1986 and 2017. Hypertension and COPD were significantly less prevalent in the Infrarenal group (P=0.0013 and 0.0017). Intraoperatively, Type IV TAAA repair was associated with a significantly higher EBL (P<0.001) and blood transfusion requirements). Postoperatively, Type-IV TAA was also associated with significantly higher pulmonary complications (P<0.001). Infrarenal AAA repair was associated with the lowest incidence of postoperative myocardial infarction (P=0.0493). There was no significant survival difference among different aneurysm subgroups (P=0.24). Conclusion: In our cohort, suprarenal AAA had a higher incidence of hypertension and COPD. As expected, Type-IV TAAA repair was associated with a higher rate of perioperative complications. Long-term survival does not appear to be different among aneurysm subgroups.