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Home > Vascular Annual Meeting > RR28. In-Hospital Mortality of Open Thoracoabdominal...

RR28. In-Hospital Mortality of Open Thoracoabdominal Aortic Aneurysm Repair in the United States Prior to Widespread Use of Hybrid and Endovascular Branched Techniques

Gustavo S. Oderich1, Eric B. Rosero2, Joseph J. Ricotta, II1, Peter Gloviczki1, Thomas C. Bower1, Audra A. Duncan1, Manju Kalra1, Carlos Timaran2
1Mayo Clinic, Rochester, MN; 2University of Texas Southwestern, Dallas, TX

OBJECTIVES: Hybrid debranching procedures and branched stent grafts have been proposed as alternative treatments to lower the morbidity and mortality associated with open thoracoabdominal aortic aneurysm (TAAA) repair. The purpose of this study was to determine in-hospital mortality and factors predicting in-hospital death after open repair of TAAA in the United States (US) prior to the widespread use of new technologies.

METHODS: The Nationwide Inpatient Sample (NIS) identified open repair procedures for non-ruptured TAAA during the years 2000-2006. Risk stratification was based on the Charlson comorbidity index (CCI), which provides aggregate measures of 18 clinical parameters. Weighted logistic regression analyses were used to determine independent predictors of in-hospital mortality and complications taking into account the NIS sample design.

RESULTS: There were 5,776 open repairs for non-ruptured TAAA performed during the 7-year period. The median age was 70 years and 43% were women. Major comorbidities included hypertension (56%), chronic pulmonary disease (35%), chronic renal insufficiency (11%) and prior myocardial infarction (8%). The in-hospital mortality was 16%. Postoperative complications included acute renal insufficiency (25%), respiratory insufficiency (10%), acute mesenteric ischemia (3%) and myocardial infarction (3%). Acute renal insufficiency (ARI) was the main independent predictor of in-hospital mortality (odds ratio [OR], 3.5; 95% confidence interval [95% CI], 3.0-4.1), and independent factors associated with higher postoperative ARI rates were age, CCI, chronic renal insufficiency, rural and non-teaching hospital. In addition to ARI, logistic regression analysis identified age, male gender, chronic renal insufficiency, CCI, and rural and non-teaching hospital location as independent predictors for in-hospital death.

CONCLUSIONS: Open surgical treatment of TAAAs carries high in-hospital mortality (16%) in the U.S. Renal insufficiency, age, gender, higher Charlson comorbidity index, and rural and non-teaching hospital are important predictors of in-hospital death. These benchmark data provide a standard for comparison against which surgeons can compare their own results with newer hybrid and endovascular branched techniques proposed to treat TAAA.

AUTHOR DISCLOSURES: G.S. Oderich, Cook Medical and WL Gore; E.B. Rosero, None; J.J. Ricotta, None; P. Gloviczki, None; T.C. Bower, None; A.A. Duncan, None; M. Kalra, None; C. Timaran, None.