Failure to rescue trends in elective abdominal aortic aneurysm repair between 1995 and 2011

Abstract

The success in AAA surgery of rescuing patients from 30-day mortality after a complication is associated with increased volume of EVAR. This increased success can also be attributed to the improved FTR outcomes and complication rates when surgeries are performed at high-volume hospital centers.

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

“…Consistent with this notion, we demonstrate that renal insufficiency, concomitant peripheral arterial disease, and the presence of multiple comorbidities are independent risk factors for FTR after AAA repair within our elderly cohort. These findings are similar to prior reports demonstrating that comorbidities significantly increase the risk of poor outcomes after AAA repair 16,18 and suggest that perhaps older patients with multiple comorbidities are less fit for surgery due to poor protoplasm. By subjecting marginal operative candidates to major surgery, we may be exposing them to a stressor that their already-compromised health status cannot tolerate.…”

“…Consistent with this notion, a study by Illonzo et al showed a progressive increase in risk of FTR after elective AAA repair with every 5-y increase in age above 69 y. 16 Interestingly, we found that the risk of FTR for an elderly patient undergoing AAA repair was similar regardless of operative approach. Although elderly patients undergoing OAR had a higher risk of FTR than those undergoing EVAR on univariable analysis, the difference was mitigated after risk adjustment.…”

“…8 Similarly, Illonzo et al reported a 3-fold increase in risk of FTR after elective OAR versus EVAR. 16 These findings suggest that, although EVAR may carry a lower risk of serious complications compared to OAR in the general population, the consequences of having a serious postoperative complication in the elderly are much greater regardless of the operative approach. 8 The lack of difference in FTR rates after EVAR and OAR in the older population suggests that FTR is related to patientspecific risks for poor outcomes, rather than the risks inherent to a given procedure.…”

“…2,7,16 For example, Illonzo et al found that the rates of FTR following OAR and EVAR in a Medicare population were 1.6% and 5.0%, respectively. 16 Given that advanced age has been associated with greater risk of FTR following injury, cholecystectomy, transurethral prostatectomy, and cardiac surgery, 9,13,16,17 it follows that the rate of FTR following AAA in the elderly would be higher than that seen in the general population. Consistent with this notion, a study by Illonzo et al showed a progressive increase in risk of FTR after elective AAA repair with every 5-y increase in age above 69 y.…”

“…This is consistent with previously published data. 4,16 Although gender in and of itself is not considered to be a specific criterion of frailty, it is well documented that female gender is positively correlated with the prevalence of frailty. [23][24][25][26][27] Female gender is also associated with higher risk of mortality due to frailty.…”