Arin L. Madenci1, Karen J. Ho2, Matthew T. Menard2
1University of Michigan Medical School, Ann Arbor, MI; 2Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, MA.
OBJECTIVES: Unplanned events including readmissions (URA) and re-operations are of increasing interest in the current era of medical cost containment. We investigated the influence of surgical approach to abdominal aortic aneurysm (AAA) repair on such events.
METHODS: Patients undergoing open (OPEN) or endovascular (EVAR) non-ruptured AAA repair were identified in the 2011 NSQIP database. We examined risk factors of 30-day rates of URA and reoperation with multivariable analyses.
RESULTS: 4,925 patients underwent EVAR (76%) or OPEN (24%) AAA repair. OPEN was associated with higher rates of reoperation (9% vs. 5%. p<0.01), wound infections (3% vs. 2%. p=0.01) and mortality (5% vs. 3%. p<0.01) on univariable analysis. The overall URA rate was 8%. There was no effect of surgical approach on URA with univariable (EVAR 8% vs. OPEN 8%. p=0.65) or multivariable (EVAR adjusted odds ratio [OR]=0.7, 95% confidence interval [CI]=0.5-1.2. p=0.25) analysis. On multivariable analysis, reoperation was significantly associated with OPEN repair (OR=1.9, 95% CI=1.3-2.7. p<0.01), emergency surgery (OR=2.3, 95% CI=1.4-3. 8. p<0.01), pre-operative dyspnea (OR=1.9, 95% CI=1.3-2.9. p<0.01) and coagulopathy (OR=1.7, 95% CI=1.1-2.6. p=0.03). Multivariable risk factors for URA were post-operative occurrences, including superficial surgical site infection (SSI; OR=6.9, 95% CI=2.9-16.6. p<0.01), deep SSI (OR=8.2, 95% CI=1.7-39.3. p<0.01), UTI (OR=5.9, 95% CI=2.9-11.8. p<0.01), myocardial infarction (OR=9.7, 95% CI=3.5-26. 8. p<0.01), pulmonary embolism (OR=47.0, 95% CI=8.4-262.6. p<0.01), progressive renal failure (OR=4.3, 95% CI=1.3-14.8. p=0.02) and re-operation (OR=11.1, 95% CI=6.3-19.5. p<0.01). Among pre-operative risk factors, only pre-surgery admission (OR=1.92, 95% CI=1.27-2.90. p<0.01) and female gender (OR=1.8, 95% CI=1.3-2.7. p<0.01) were associated with URA.
CONCLUSIONS: While OPEN AAA repair was associated with higher post-operative reoperation rates, this did not translate into increased URA rate compared with EVAR.
AUTHOR DISCLOSURES: K. J. Ho: Nothing to disclose; A. L. Madenci: Nothing to disclose; M. T. Menard: Nothing to disclose.
Posted April 2013