Abdominal aortic aneurysm repair in octogenarians is associated with higher mortality compared with nonoctogenarians

Hicks, Caitlin W.; Obeid, Tammam; Arhuidese, Isibor; Qazi, Umair; Malas, Mahmoud B.

doi:10.1016/j.jvs.2016.03.440

Cited by 68 publications

(64 citation statements)

References 26 publications

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“…34,35 Age and comorbidities are associated with poor outcomes but are not useful as tools for determining candidacy for surgery given the heterogeneity of outcomes. 36,37 Frailty, however, has consistently been shown to predict poor outcomes, and more evidence continues to accumulate that frailty is multidimensional and goes beyond merely comorbidities and functional status. The advantage of the RAI is the capture of five domains of frailty; namely, functional, physical, social, cognitive, and nutritional.…”

Section: Discussionmentioning

confidence: 99%

Variation in center-level frailty burden and the impact of frailty on long-term survival in patients undergoing elective repair for abdominal aortic aneurysms

George

Chen

Trickey

et al. 2020

Journal of Vascular Surgery

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Objective: Frailty is increasingly recognized as a key determinant in predicting postoperative outcomes. Centers that see more frail patients may not be captured in risk adjustment, potentially accounting for poorer outcomes in hospital comparisons. We aimed to (1) determine the effect of frailty on long-term mortality in patients undergoing elective abdominal aortic aneurysm (AAA) repair and (2) evaluate the variability in frailty burden among centers in the Vascular Quality Initiative (VQI) database. Methods:Patients undergoing elective open and endovascular AAA repair (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017) were identified, and those with complete data on component variables of the VQI-derived Risk Analysis Index (VQI-RAI) and centers with $10 AAA repairs were included. VQI-RAI characteristics are sex, age, body mass index, renal failure, congestive heart failure, dyspnea, preoperative ambulation, and functional status. Frailty was defined as VQI-RAI $35 based on prior work in surgical patients using other quality improvement databases. This corresponds to the top 12% of patients at risk in the VQI. Center-level VQI-RAI differences were assessed by analysis of variance test. Relationships between frailty and survival were compared by Kaplan-Meier analysis and the log-rank test for open and endovascular procedures. Multivariable hierarchical Cox proportional hazards regression models were calculated with random intercepts for center, controlling for frailty, race, insurance, AAA diameter, procedure type, AAA case mix, and year.Results: A total of 15,803 patients from 185 centers were included. Mean VQI-RAI scores were 27.6 (standard deviation, 5.9; range, 4-56) and varied significantly across centers (F ¼ 2.41, P < .001). The percentage of frail patients per center ranged from 0% to 40.0%. In multivariable analysis, frailty was independently associated with long-term mortality (hazard ratio, 2.88; 95% confidence interval, 2.6-3.2) after accounting for covariates and center-level variance. Open AAA repair was not associated with long-term mortality after adjusting for frailty (hazard ratio, 0.98; 95% confidence interval, 0.86-1.13). There was a statistically significant difference in the percentage of frail patients compared with nonfrail patients who were discharged to a rehabilitation facility or nursing home after both open (40.5% vs 17.8%; P < .0001) and endovascular repair (17.7% vs 4.6%; P < .0001). Conclusions:There is considerable variability of preoperative frailty among VQI centers performing elective AAA repair. Adjusting for center-level variation, frailty but not procedure type had a significant association with long-term mortality; however, frailty and procedure type were both associated with nonhome discharge. Routine measurement of frailty preoperatively by centers to identify high-risk patients may help mitigate procedural and long-term outcomes and improve shared decision-making regarding AAA repair. (J Vasc Surg 2020;71:46-55.)

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Section: Discussionmentioning

confidence: 99%

Variation in center-level frailty burden and the impact of frailty on long-term survival in patients undergoing elective repair for abdominal aortic aneurysms

George

Chen

Trickey

et al. 2020

Journal of Vascular Surgery

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“…Previously, we demonstrated that the risk of AAA repair in the elderly population is significantly higher than that of the general population. 6 One explanation for this difference may be that elderly patients are at higher risk for FTR compared to their younger counterparts; prior studies reporting on the risk of FTR after AAA repair have shown that increasing age is an independent risk factor for perioperative mortality following AAA repair. 15 In the present study, we sought to identify independent risk factors for FTR following elective open and endovascular AAA repair in an elderly population.…”

Section: Discussionmentioning

confidence: 99%

“…Elderly was defined as all patients with age !80 y, in accordance with our prior work on this topic. 6 Patients who underwent elective infrarenal repair without perioperative complications, underwent urgent or emergent AAA repair, those with suprarenal or juxtarenal AAA, and those with incomplete or missing outcomes data were excluded. The study was approved by the Vascular Quality Initiative Patient Safety Organization and the Johns Hopkins Institutional Review Board.…”

Section: Study Cohortmentioning

confidence: 99%

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Predicting failure to rescue after abdominal aortic aneurysm repair in elderly patients

Hicks

O’Kelly

Obeid

et al. 2017

Journal of Surgical Research

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“…The pulsatile character of blood flow in the arterial system causes a strong and recurrent stretch of arteries' walls that may result in its damage, especially in the case of pre-existing alterations such as atherosclerosis [8]. However, wall stress and wall strength cannot be directly measured in vivo [9].…”

Section: Introductionmentioning

confidence: 99%

Artificial Circulatory Model for Analysis of Human and Artificial Vessels

et al. 2018

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Abstract:Background: Ex vivo computer controlled circulatory reactors are advantageous for the investigation of circulatory systems. So far, most of the models have dealt with laminar or pulsatile flow. This study aimed to monitor blood vessel and vessel graft compliance continuously under physiological flow in real time. Methods: Human common iliac arteries and silicon tubes served as interposition grafts. Changes in wall diameter and displacement were analyzed. The artificial circulatory system (ACM) presented an "artificial heart" able to simulate various ejection pressures, ejection volumes (EV), and frequencies of pulsation (FP). ACM was validated by comparing medical data reconstructed with the 2D-speckle-tracking-technique (2DSTT). Results: Silicon tubes were more rigid compared to iliac arteries, as changes in diameter were approximately 48% lower (0.56 ± 0.007 mm vs. 0.83 ± 0.016 mm, p < 0.0001, for EV = 70 mL and FP = 60 min −1 ). Wall displacement was 2.3-fold less pronounced in silicon tubes (1.45 ± 0.032 mm vs. 5.79 ± 0.043 mm for iliac arteries (p < 0.0001)). FP and EV did not further increase differences in wall displacement between both types of grafts. There were no significant changes between results gathered from ACM and 2DSTT. Conclusions: The ACM was successfully validated by 2DSTT with the use of selected grafts. It may become a useful tool to investigate different types of vascular grafts.

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Abdominal aortic aneurysm repair in octogenarians is associated with higher mortality compared with nonoctogenarians

Cited by 68 publications

References 26 publications

Variation in center-level frailty burden and the impact of frailty on long-term survival in patients undergoing elective repair for abdominal aortic aneurysms

Variation in center-level frailty burden and the impact of frailty on long-term survival in patients undergoing elective repair for abdominal aortic aneurysms

Predicting failure to rescue after abdominal aortic aneurysm repair in elderly patients

Artificial Circulatory Model for Analysis of Human and Artificial Vessels

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