Incidence and Outcomes of Severe Renal Impairment Following Ruptured Abdominal Aortic Aneurysm Repair

Ambler, Graeme K.; Coughlin, Patrick A.; Hayes, Paul D.; Varty, K.; Gohel, M.S.; Boyle, J.R.

doi:10.1016/j.ejvs.2015.06.024

Cited by 45 publications

(44 citation statements)

References 26 publications

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“…It also looks at whether there are differences in morbidity rates for patients treated at the weekend or out of hours in more detail than existing work – an important consideration given the high rates of morbidity experienced by this patient population14 15. The mortality rate for patients with ruptured aneurysms in this data set was 37·1 per cent, which is in line with figures from the recent IMPROVE study10, an RCT comparing endovascular and open repair strategies for ruptured AAA, giving confidence that outcomes are in line with other published figures from a UK cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Patients treated acutely for AAA also experience significant morbidity, as highlighted by recent reports14 15 focusing on acute kidney injury after ruptured AAA repair. Assessments of differences in morbidity rates for patients treated at the weekend are notably absent from previous studies, perhaps because the large administrative databases used tend not to record these outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Weekend effect in non-elective abdominal aortic aneurysm repair

et al. 2017

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BackgroundThe ‘weekend effect’ describes the phenomenon where patient outcomes appear worse for those admitted at the weekend. It has been used recently to justify significant changes in UK health policy. Recent evidence has suggested that the effect may be due to a combination of inadequate correction for confounding factors and inaccurate coding. The effects of these factors were investigated in patients with acute abdominal aortic aneurysm (AAA).MethodsPatients undergoing non‐elective AAA repair entered into the UK National Vascular Registry from January 2013 until December 2015 were included in a case–control study. The patients were divided according to whether they were treated during the week (Monday 08.00 hours to Friday 17.00 hours) or at the weekend. Data extracted included demographics, co‐morbidities, preoperative medications and baseline blood test results, as well as outcomes. Coding issues were investigated by looking at patients treated for ruptured, symptomatic or asymptomatic AAA within the non‐elective cohort. The primary outcome was in‐hospital mortality. Secondary outcomes included length of inpatient stay, and cardiac, respiratory and renal complications.ResultsThe mortality rate appeared to be higher at the weekend (odds ratio (OR) 1·69, 95 per cent c.i. 1·47 to 1·94; P < 0·001), but this effect disappeared when confounding factors and coding issues were corrected for (corrected OR for ruptured AAA 1·09, 0·92 to 1·29; P = 0·330). Differences in outcomes were similar for prolonged length of hospital stay (uncorrected OR 1·21, 95 per cent c.i. 1·06 to 1·37, P = 0·005; corrected OR for ruptured AAA 1·06, 0·91 to 1·10, P = 0·478), and morbidity outcomes.ConclusionAfter appropriate correction for confounding factors and coding effects, there was no evidence of a significant weekend effect in the treatment of non‐elective AAA in the UK.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Weekend effect in non-elective abdominal aortic aneurysm repair

et al. 2017

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“…We have demonstrated that there is a 22-fold increase in the odds of mortality when postoperative ARF develops (OR, 22.30; 95% CI, 11.93-41.69; P < .001), which confirms results from prior studies. 7,39 Furthermore, dialysis and the extended length of stay in the hospital due to postoperative ARF add to the financial burden of EVAR on the health care system because hemodialysis is fully covered by Medicare services.…”

Section: Discussionmentioning

confidence: 99%

“…1,5,6 The risk is even higher (26%) in patients with ruptured AAA who survived the first 24 hours after EVAR. 7 Of note, the 5-year follow-up of the Dutch Randomized Endovascular Aneurysm Management (DREAM) trial estimated an average decline of estimated glomerular filtration rate (eGFR) of 0.9 (63.9) mL/min/1.73 m 2 per year after EVAR, and this decline was similar to what is observed after open repair. 8 …”

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confidence: 87%

Concurrent renal artery stent during endovascular infrarenal aortic aneurysm repair confers higher risk for 30-day acute renal failure

Nejim

Arhuidese

Rizwan

et al. 2017

Journal of Vascular Surgery

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Objective Concurrent renal artery angioplasty and stenting (RAAS) during endovascular aneurysm repair (EVAR) of infrarenal abdominal aortic aneurysm (AAA) has been practiced in an attempt to maintain renal perfusion. The aim of this study was to identify the current practice of RAAS during EVAR and its effect on perioperative renal outcome. Methods Patients with infrarenal AAA were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP, 2011-2014) database. Baseline characteristics of patients with concurrent RAAS during EVAR were compared with those of patients who underwent EVAR only. Bivariate and multivariable logistic regression analyses controlling for patients’ demographics, comorbidities, and operative factors were used to evaluate the predictors of 30-day acute renal failure (ARF). Sensitivity analysis was done to evaluate the role of RAAS in patients with prior kidney disease. Results Overall, 6183 patients underwent EVAR for infrarenal AAA during the study period. Of them, 281 patients had RAAS during EVAR (4.5%). The median age of the patients was 74 years; 81.7% of the cohort was male, but a higher proportion of female patients received EVAR + RAAS compared with patients who underwent EVAR only (26.3% vs 17.9%; P < .001). There was no difference between groups in terms of comorbidities, being on dialysis, or functional status, yet the EVAR + RAAS group had a higher proportion of patients with glomerular filtration rate <60 mL/min/1.73 m2 (45.2% vs 37.2%; P = .011). RAAS was associated with significantly higher odds for development of ARF (adjusted odds ratio [aOR], 4.27; 95% confidence interval [CI], 2.06-8.84; P < .001). Other highly predictive factors of 30-day ARF were glomerular filtration rate <60 (aOR, 2.92; 95% CI, 1.47-5.78; P = .002), emergency status (aOR, 2.97; 95% CI, 1.21-7.27; P = .017), and ruptured AAA as the indication for EVAR (aOR, 4.74; 95% CI, 1.80-12.50; P = .002). Patients with prior kidney disease who had EVAR + RAAS demonstrated a 12-fold higher odds for 30-day ARF (aOR, 12.37; 95% CI, 4.66-32.89; P < .001). Conclusions Concurrent RAAS was found to be a significant determinant of adverse renal outcomes after EVAR for infrarenal AAA. This effect was present even after controlling for patients’ risk factors that might contribute to postoperative ARF.

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“…AKI in the context of emergency ruptured AAA repair is well described and expected given the nature of the typical in extremis presentation (12). Again, open surgical repair, especially if suprarenal clamping is required intraoperatively, inevitably results in some renal ischemia (13).…”

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confidence: 99%