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

Hicks, Caitlin W.; O’Kelly, Anna C.; Obeid, Tammam; Locham, Satinderjit; Malas, Mahmoud B.

doi:10.1016/j.jss.2017.06.025

Cited by 20 publications

(11 citation statements)

References 32 publications

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“…Of all octogenarians who were deceased within 30 days of AAA repair, 45.6% had AKI during their hospital stay. A similar finding was also reported by Hicks et al 16 where, of all postoperative complications, FTR in octogenarians was most commonly associated with AKI.…”

Section: Discussionsupporting

confidence: 89%

“…The risks and benefits of AAA repair in elderly patients have been extensively discussed in recent publications, including those from our group. [14][15][16] Among the complications after infrarenal AAA repair, which is a major reason for increased morbidity, prolonged duration of stay and FTR after AAA repair in this patient population. Although many studies have concentrated on AKI after AAA repair, there is little information on this major postoperative complication in octogenarians.…”

Section: Discussionmentioning

confidence: 99%

“…þ (b x *risk factor x); where b x represents the regression coefficients of the respective risk factor obtained from the multivariable model. The estimated probability percentage of postoperative AKI of a patient, the final output of the risk calculator, was then computed as follows 16,17 :…”

Section: Methodsmentioning

confidence: 99%

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Predictors of acute kidney injury after infrarenal abdominal aortic aneurysm repair in octogenarians

Dang

Dakour-Aridi

Rizwan

et al. 2019

Journal of Vascular Surgery

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Predictors of acute kidney injury after infrarenal abdominal aortic aneurysm repair in octogenarians

Dang

Dakour-Aridi

Rizwan

et al. 2019

Journal of Vascular Surgery

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“…10,25 However, the influence of age on outcomes like FTR cannot be underestimated. 26 In this study there were only a few baseline characteristics of influence on FTR with the majority for overall and acute AAA surgery indicating that in general, FTR is merely influenced by hospital characteristics instead of casemix. Hospital volume was not found to be associated with FTR.…”

Section: Discussionmentioning

confidence: 60%

Failure to Rescue – a Closer Look at Mortality Rates Has No Added Value for Hospital Comparisons but Is Useful for Team Quality Assessment in Abdominal Aortic Aneurysm Surgery in The Netherlands

Lijftogt

Karthaus

Vahl

et al. 2018

European Journal of Vascular and Endovascular Surgery

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“…40,43 Studies suggest that increased frailty and decreased BMI often go hand in hand, and while in a chronic setting, obesity is hazardous, in an acute event such as rAAA, high albumin, and good nutritional in obese patients compared to frail patients could provide survival benifit. 49…”

Section: Discussionmentioning

confidence: 99%

Endograft type and anesthesia mode are associated with mortality of endovascular aneurysm repair for ruptured abdominal aortic aneurysms

et al. 2020

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Objective Endovascular aneurysm repair has become the primary treatment modality for ruptured infrarenal abdominal aortic aneurysm. This study examines the impact of endograft type on perioperative outcomes for ruptured infrarenal abdominal aortic aneurysm. Method The targeted endovascular aneurysm repair files of the American College of Surgeons National Surgical Quality Improvement Program database (2012–2017) were used. Only patients treated for ruptured infrarenal abdominal aortic aneurysm were included. All patients requiring concomitant stenting of the visceral arteries or aneurysmal iliac arteries or open abdominal surgery were excluded. The characteristics of patients treated with the different endografts and the corresponding outcomes were compared using Stata software. Results There were 479 patients treated with the three most common endografts: Cook Zenith ( n = 127), Gore Excluder ( n = 239), and Medtronic Endurant ( n = 113). The number of other endografts was too small for statistical analysis. Compared to patients treated with Excluder or Endurant, the patients treated with Zenith had significantly lower body mass index ( P < .001) and were less likely to be white ( P < .001). On the other hand, patients treated with Endurant were less likely to be smoker ( P = .016). Patients treated with Zenith had significantly larger ruptured infrarenal abdominal aortic aneurysm diameter ( P = .045). The overall mortality was 18% and morbidity 74.3%. There was a statistically significant difference in overall mortality (Zenith = 11.8%, Excluder = 18%, Endurant = 24.8%, P = .033) but not morbidity ( P = .808) between the three groups. Post hoc analysis for overall mortality showed only significant difference between Zenith and Endurant. The difference in mortality was not significant in patients presenting with ruptured infrarenal abdominal aortic aneurysm without hypotension ( P = .065). On multivariable analysis, treatment with the Endurant endograft was associated with increased mortality compared to Zenith (odds ratio = 3.0 [confidence interval 1.31–6.7]). General anesthesia (odds ratio = 2.67 [confidence interval 1.02–7.02]), rupture with hypotension (odds ratio = 4.49 [confidence interval 2.54–7.95]), and dependent functional status (odds ratio = 5.7 [confidence interval 1.96–16.59]) were independently associated with increased mortality while increasing body mass index (odds ratio = 0.97 [confidence interval 0.95–0.99]) was associated with reduced risk of mortality. Conclusions This study highlights contemporary outcomes of endovascular aneurysm repair for ruptured infrarenal abdominal aortic aneurysm with relatively low mortality. Endograft type and anesthesia technique are modifiable factors that can potentially improve outcomes. Significant variation in the outcomes of the different endografts warrants further research.

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

Cited by 20 publications

References 32 publications

Predictors of acute kidney injury after infrarenal abdominal aortic aneurysm repair in octogenarians

Predictors of acute kidney injury after infrarenal abdominal aortic aneurysm repair in octogenarians

Failure to Rescue – a Closer Look at Mortality Rates Has No Added Value for Hospital Comparisons but Is Useful for Team Quality Assessment in Abdominal Aortic Aneurysm Surgery in The Netherlands

Endograft type and anesthesia mode are associated with mortality of endovascular aneurysm repair for ruptured abdominal aortic aneurysms

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