Risk Factors for Postoperative Complications after Open Infrarenal Abdominal Aortic Aneurysm Repair in Koreans

Abstract

PurposeOpen infrarenal abdominal aortic aneurysm (AAA) repair is performed without event in most cases. However, some patients suffer major morbidities such as renal failure, myocardial infarction, paraplegia, acute respiratory distress syndrome, or hepatic dysfunction. Predicting what kinds of patient populations are more prone to develop such complications may keep the clinicians more attentive to the patients, possibly leading to better prognoses. In this retrospective study, we searched the incidence of and risk factors for postoperative complications and their predictive equations in 162 patients who underwent open infrarenal AAA repair.Materials and MethodsPostoperative complications were observed within 30 days. Patient characteristics, types of aneurysm and surgery, and hemodynamic and metabolic variables during the periclamp period were analyzed in relation to postoperative complications using multiple logistic regression analysis.ResultsPostoperative complications involved the cardiac (20%), pulmonary (14%), renal (13%), gastrointestinal (6%), hepatic (3.1%), and neurologic (2.5%) systems, and bleeding occurred in 1.2% of cases. The mortality rate was 5.6%. The risk factors were age [> 67 yrs, odds ratio (OR) 2.6], clamp duration (> 110 min, OR 4.7), volume of blood transfusion (> 1,280 mL, OR 4.4), emergency operation (OR 1.4), and vasopressor infusion during clamp (OR 1.4). The prediction model was: P(x) = exp(α)/[1 + exp(α)] α;-2.2 + 0.9 × age + 1.5 × clamp duration + 1.5 × transfusion + 0.3 × emergency + 0.4 × vasopressor infusion [insert 1 if risk factors exist, otherwise, insert 0 to each variable].ConclusionA significant number of complications occurred after infrarenal AAA repair. Therefore, creating a protocol to identify and monitor high risk patients would improve postoperative care.

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

“…That vasopressor use and urgent/emergent status are associated with higher risk of mortality is not surprising because they are surrogate markers for patient instability. A number of prior reports on AAA outcomes have similarly reported that both vasopressors 15,16 and acuity 17,18 are associated with high mortality risks. In contrast, octogenarian status as an independent predictor of mortality is relatively novel.…”

“…Univariable and multivariable statistics were used to compare perioperative (30-day) and 1-year mortality outcomes between octogenarians vs nonoctogenarians for OAR and EVAR. Results: During the study period, 21,874 patients underwent AAA repair (OAR, 5765; EVAR,16,109), including 4839 octogenarians (OAR, 765; EVAR, 4074) and 17,035 nonoctogenarians (OAR, 5000; EVAR, 12,035). Octogenarians (mean age, 83.0 6 0.1 years) were less frequently male (66% vs 75%) and had a higher prevalence of congestive heart failure (9.9% vs 7.1%), chronic renal insufficiency (12.2% vs 7.5%), and a history of aortic surgery (14.3% vs 7.7%) compared with nonoctogenarians (P < .01 for all).…”

Protective Effect of Thymosin β4 against Abdominal Aortic Ischemia–Reperfusion-Induced Acute Lung Injury in Rats

“…Occlusion and reperfusion of the infrarenal abdominal aorta (IAA) occurs in humans during perivascular surgery [1] and when applied in experimental animal models [2,3]. This method is known to cause ischemia–reperfusion injury (IRI) in various distant organs, such as the kidney, heart, and lungs, which may lead to multiple organ dysfunction syndrome (MODS).…”

Proteomics in aortic aneurysm – What have we learnt so far?

“…Surgical excision of the affected area and replacement by interposition Dacron grafts is the gold standard for treatment if the dilatation of the aorta exceeds 0.5 cm/year or the ascending aorta is greater than 5 cm in diameter . The conventional surgical approach carries the risks of bleeding, infection, stroke and graft failure . While minimally invasive interventions are getting more frequently used in the treatment of AAA , the use of expanding endovascular stent‐grafts is more limited in ascending AAs due to the presence of branching vessels in the aortic arch .…”