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 PS24. Frailty Does Not Increase Risk in Thoracic Endovascular Aortic Repair

​Matthew A. Schechter, Asvin M. Ganapathi, Brian R. Englum, Jennifer M. Hanna, Richard McCann, G. Chad Hughes
Duke University Medical Center - Department of Surgery, Durham, NC.

OBJECTIVES: Frailty has been examined in various populations as a predictor of morbidity/mortality, but not in patients undergoing thoracic endovascular aortic repair (TEVAR). The objective of this study was to evaluate the role of frailty, as represented by total psoas volume (TPV), in predicting morbidity and mortality following TEVAR.
 
METHODS: Retrospective analysis was performed on all patients undergoing TEVAR between June 2005 and October 2012 at a single referral institution. Risk models for 30-day and 1-year mortality, 30 day major morbidity and discharge to a facility were calculated using logistic regression modeling. Major morbidity was defined as re-operation, prolonged mechanical ventilation, acute renal failure, new onset dialysis, stroke, discharge to a facility and/or LOS >14 days.
 
RESULTS: Three hundred eighty-three patients were identified, with 338 (88%) having data points for all variables used in the final model. Mortality for the cohort at 30 days and 1 year was 7% (n=23) and 19% (n=62), respectively, while incidence of major morbidity was 33% (n=108). TPV was not a statistical significant predictor of 30-day or 1-year outcomes. History of stroke and ASA class 4 were significant predictors of all outcomes except 30 day mortality, with which age, procedure type and non-elective status were statistically associated (Table 1).
 
CONCLUSIONS: Frailty, as determined by TPV, does not predict outcomes in TEVAR. An endovascular approach may reduce the effect of frailty on morbidity and mortality following TEVAR.
 
AUTHOR DISCLOSURES: B. R. Englum: Nothing to disclose; A. M. Ganapathi: Nothing to disclose; J. M. Hanna: Nothing to disclose; G. Hughes: W.L. Gore, Consulting fees or other remuneration (payment); Vascutek Terumo, Consulting fees or other remuneration (payment); R. McCann: Nothing to disclose; M. A. Schechter: Nothing to disclose.
 
Table 1
30-day Mortality
30 day Major Morbidity
Discharge to Facility
LOS >14 Days
1-Year Mortality
Odds Ratio (p-value)
Odds Ratio (p-value)
Odds Ratio (p-value)
Odds Ratio (p-value)
Odds Ratio (p-value)
Prior Stroke
NS
2.42 (0.019)
2.35 (0.045)
3.42 (0.006)
3.07 (0.005)
ASA Class 4
NS
3.49 (<0.001)
3.04 (0.002)
3.58 (0.001)
2.17 (0.013)
Maximal Aortic Diameter (cm)
NS
NS
NS
NS
1.26 (0.016)
Repair Type Descending-only Hybrid Arch Hybrid ​Thoracoabdominal
NS 7.33 (<0.001) 4.36 (0.021)
NS 2.40 (0.006) 3.83 (<0.001)
NS 7.44 (<0.001) 5.05 (<0.001)
NS NS NS
NS 2.12 (0.030) NS
Non-elective Status
2.87 (0.045)
NS
2.88 (0.013)
NS
NS
Increasing Age
1.05 (0.021)
NS
1.06 (<0.001)
NS
1.03 (0.005)
Increasing BMI
NS
NS
NS
NS
0.93 (0.025)

 


NS: Non-significant

Posted April 2013

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