Comprehensive Assessment of Factors Associated With In-Hospital Mortality After Elective Abdominal Aortic Aneurysm Repair

Hicks, Caitlin W.; Canner, Joseph K.; Arhuidese, Isibor; Obeid, Tammam; Black, James H.; Malas, Mahmoud B.

doi:10.1001/jamasurg.2016.0782

Cited by 39 publications

(25 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…12 Recent studies have demonstrated better survival outcomes among patients treated with EVAR at high-volume institutions, especially when the patients have multiple comorbidities. 13,14 With this centralization of EVAR comes a concern about compliance of the patient with postoperative surveillance. Although some data exist suggesting that distance from a tertiary care center is not a limiting factor in the patient’s adherence to follow-up after EVAR, 15 others have shown that shorter driving distances are independent predictors of compliance with postoperative imaging surveillance.…”

Section: Discussionmentioning

confidence: 99%

Endovascular aneurysm repair patients who are lost to follow-up have worse outcomes

Hicks

Zarkowsky

Bostock

et al. 2017

Journal of Vascular Surgery

Self Cite

View full text Add to dashboard Cite

Background Society for Vascular Surgery practice guidelines recommend 1- and 12-month follow-up with computed tomography imaging for the year after endovascular aneurysm repair (EVAR). We describe the incidence, risk factors, and outcomes of EVAR patients who are lost to follow-up (LTF). Methods All patients undergoing elective EVAR in the Vascular Quality Initiative (VQI) data set (January 2003-December 2015) were stratified according to long-term follow-up method (in-person vs phone call vs LTF). Mortality was captured for all patients by linkage with the Social Security Death Index. Univariable statistics, Kaplan-Meier estimated survival curves, and Cox proportional hazard modeling were used to compare groups. Coarsened exact matching analysis was then performed to refine the association between LTF and risk of post-EVAR death. Results During the study period, 11,309 patients underwent elective EVAR (78% in-person follow-up, 11% phone call follow-up, 11% LTF). On univariable analysis, LTF patients had larger baseline aneurysms, higher American Society of Anesthesiologists scores, more comorbidities, and worse baseline functional status compared to patients with in-person or phone call follow-up (P ≤ .05). Procedural factors (contrast material volume, blood transfusions, postoperative vasopressor use) were higher in the LTF group, as was the incidence of postoperative complications (P ≤ .05). Accordingly, LTF patients had longer postoperative lengths of stay and were less frequently discharged to home (P < .001). Five-year survival was lower for LTF vs phone call follow-up vs in-person follow-up (62% vs 68% vs 84%; P < .001). On multivariable analysis correcting for baseline differences between groups, there was a significantly higher risk of death for both the LTF group (hazard ratio, 6.45; 95% confidence interval, 4.89-8.51) and phone call follow-up group (hazard ratio, 3.48; 95% confidence interval, 2.66-4.57) compared with patients who followed up in person (P < .001). After coarsened exact matching on 30 preoperative and perioperative variables, 5-year survival after EVAR for LTF vs phone call follow-up vs in-person follow-up was 84.9% vs 84.8% vs 91.9%, respectively (log-rank, P < .001). Notably, patients with phone call follow-up had a lower prevalence of documented postoperative imaging compared with patients with in-person follow-up (56.1% vs 85.1%; P < .001). Conclusions EVAR patients with more comorbidities and a higher incidence of in-hospital complications tend to be more frequently LTF and ultimately have worse survival outcomes. In-person follow-up is associated with better post-EVAR survival and a higher rate of postoperative imaging. Phone follow-up confers a mortality risk equivalent to lack of follow-up, possibly as a result of inadequate postoperative imaging. Surgeons should stress the importance of office-based postoperative follow-up to all EVAR patients, particularly those with poor baseline health and functional status and more complicated perioperative courses.

show abstract

Section: Discussionmentioning

confidence: 99%

Endovascular aneurysm repair patients who are lost to follow-up have worse outcomes

Hicks

Zarkowsky

Bostock

et al. 2017

Journal of Vascular Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…Complex sample data analysis adjusts for weights, cluster, and stratification of the sampling design to produce unbiased national estimates of population means and frequencies from the sample after taking into account weights for over- or under-sampling of specific groups 21 . This complex sample analysis method is comparable with a multilevel mixed-effects model with random effects for hospital 22 . The Taylor-series linearization method was used to calculate standard errors 23 .…”

Section: Methodsmentioning

confidence: 99%

Persisting disparities between sexes in outcomes of ruptured abdominal aortic aneurysm hospitalizations

Stuntz

Audibert

2017

Sci Rep

View full text Add to dashboard Cite

We sought to describe and analyze discrepancies between sexes in the outcomes of patients hospitalized for ruptured abdominal aortic aneurysms (rAAA) by conducting a retrospective analysis of the Nationwide Inpatient Sample. The review included all adult patients (≥18 years old) hospitalized with a primary diagnosis of rAAA between January 2002 and December 2014. In-hospital mortality differences between females and males were analyzed overall and separately among those receiving endovascular AAA repair (EVAR) or open AAA repair (OAR). In-hospital mortality for females declined from 61.0% in 2002 to 49.0% in 2014 (P for trend <0.001), while mortality for males declined from 48.6% in 2002 to 32.2% in 2014 (P for trend <0.001). Among those receiving EVAR, females were significantly more likely to die in the hospital than males (adjusted odds ratio [OR], 1.44; 95% CI, 1.12–1.84). In addition, the odds of mortality among those receiving OAR were higher for females than males (adjusted OR, 1.14; 95% CI: 1.00–1.31). These data provide evidence that despite overall decreasing trends in mortality for both sexes, females remain at higher risk of death compared with males regardless of surgical repair procedure.

show abstract

“…The current preference for EVAR is reflected by two large studies that comprised nearly 200,000 patients and found that EVAR was performed for 74% of all non-ruptured AAA repairs in the U.S. in 2010 15 and for 61% of those in Australia, Iceland, New Zealand, and eight European countries in 2009 16 . In fact, the proportion of U.S. hospitals where at least 25% of elective AAA repairs involved open surgery declined from 41% in 2007 to only 18% in 2011 ( p <0.001) 17 .…”

Section: Treatment Optionsmentioning

confidence: 98%

A primer on infrarenal abdominal aortic aneurysms

Hertzer

2017

F1000Res

View full text Add to dashboard Cite

Ruptured abdominal aortic aneurysms have an alarmingly high mortality rate that often exceeds 50%, even when patients survive long enough to be transported to hospitals. Historical data have shown that ruptures are especially likely to occur with aneurysms measuring ≥6 cm in diameter, but there are so many exceptions to this that several randomized clinical trials have been done in an attempt to determine whether smaller aneurysms should be repaired electively as soon as they are discovered. More recently, further trials have been conducted in order to compare the relative benefits and disadvantages of modern endovascular aneurysm repair to those of traditional open surgery. This review summarizes current evidence from randomized trials and large population-based datasets regarding two questions that are uppermost in the mind of virtually every patient who is found to have an abdominal aortic aneurysm. Should it be fixed? What are the risks?

show abstract

Comprehensive Assessment of Factors Associated With In-Hospital Mortality After Elective Abdominal Aortic Aneurysm Repair

Cited by 39 publications

References 25 publications

Endovascular aneurysm repair patients who are lost to follow-up have worse outcomes

Endovascular aneurysm repair patients who are lost to follow-up have worse outcomes

Persisting disparities between sexes in outcomes of ruptured abdominal aortic aneurysm hospitalizations

A primer on infrarenal abdominal aortic aneurysms

Contact Info

Product

Resources

About