David H. Stone1, Philip P. Goodney1, Andres Schanzer2, Jeffrey Kalish3, Jeffrey Indes4, Randall R. De Martino1, Daniel B. Walsh1, Jack L. Cronenwett1, Brian W. Nolan1
1Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; 2University of Massachusetts Medical School, Worcester, MA; 3Boston Medical Center, Boston, MA; 4Yale School of Medicine, New Haven, CT.
OBJECTIVES: Although COPD is implicated as a risk factor for AAA rupture, its impact on surgical repair remains undefined. Consequently, variation in practice persists. The purpose of this study was to analyze the impact of clinically significant COPD on patients undergoing AAA repair.
METHODS: We reviewed a regional registry of 3,156 patients undergoing elective AAA repair in New England from 2003-2011. COPD was defined as mild (diagnosis only) vs. severe (medication/oxygen). Endpoints included major postoperative adverse events(MAEs), extubation in the operating room (eOR), and long-term survival. Predictors of endpoints were determined by multivariate logistic regression and Cox-Proportional Hazards.
RESULTS: Over the study interval, 1,752 patients underwent EVAR while 1,404 patients underwent open AAA (oAAA) with nearly equal prevalence of COPD(35% EVAR, 36% oAAA). COPD was associated with increased MAE.(Fig 1) While COPD did not impact eOR (96.3% vs. 97.9%, p=0.2) in the EVAR group, it was associated with lower eOR (56.6% vs. 73.6%, p<.001) in the oAAA cohort. Five-year survival was reduced among all patients undergoing AAA repair with COPD (none-79%, mild-75%, severe-65%; p<.001). By multivariate analysis, severe COPD was independently associated with in-hospital death (O.R. 2.01 C.I. 1.0-4.0 p=.04) and diminished 5-year survival (H.R. 1.5 C.I. 1.2-1.8 p<.001).
CONCLUSIONS: COPD is associated with higher MAE and diminished long-term survival among patients undergoing elective AAA repair. Accordingly, careful evaluation of COPD severity should be done before recommending elective AAA repair.
AUTHOR DISCLOSURES: J. L. Cronenwett, Nothing to disclose; R. R. De Martino, Nothing to disclose; P. P. Goodney, Nothing to disclose; J. Indes, Nothing to disclose; J. Kalish, Nothing to disclose; B. W. Nolan, Nothing to disclose; A. Schanzer, Nothing to disclose; D. H. Stone, Nothing to disclose; D. B. Walsh, Nothing to disclose.
Posted April 2012