Functional Status Predicts Major Complications and Death After Endovascular Repair of Abdominal Aortic Aneurysms

Overview

Journal J Vasc Surg

Publisher Elsevier

Specialties Cardiology & Vascular Diseases
General Surgery

Date 2017 Mar 6

PMID 28259573

Citations 8

Authors

Donald G Harris

Ilynn Bulatao

Connor P Oates

Richa Kalsi

Charles B Drucker

Nandakumar Menon

Tanya R Flohr

Robert S Crawford

Affiliations

Soon will be listed here.

Abstract

Objective: Endovascular aneurysm repair (EVAR) is considered a lower risk option for treating abdominal aortic aneurysms and is of particular utility in patients with poor functional status who may be poor candidates for open repair. However, the specific contribution of preoperative functional status to EVAR outcomes remains poorly defined. We hypothesized that impaired functional status, based simply on the ability of patients to perform activities of daily living, is associated with worse outcomes after EVAR.

Methods: Patients undergoing nonemergent EVAR for abdominal aortic aneurysm between 2010 and 2014 were identified in the National Surgical Quality Improvement Program (NSQIP) database. The primary outcomes were 30-day mortality and major operative and systemic complications. Secondary outcomes were inpatient length of stay, need for reoperation, and discharge disposition. Using the NSQIP-defined preoperative functional status, patients were stratified as independent or dependent (either partial or totally dependent) and compared by univariate and multivariable analyses.

Results: Of 13,432 patients undergoing EVAR between 2010 and 2014, 13,043 were independent (97%) and 389 were dependent (3%) before surgery. Dependent patients were older and more frequently minorities; had higher rates of chronic pulmonary, heart, and kidney disease; and were more likely to have an American Society of Anesthesiologists score of 4 or 5. On multivariable analysis, preoperative dependent status was an independent risk factor for operative complications (odds ratio [OR], 3.1; 95% confidence interval [CI], 2.5-3.9), systemic complications (OR, 2.8; 95% CI, 2.0-3.9), and 30-day mortality (OR, 3.4; 95% CI, 2.1-5.6). Secondary outcomes were worse among dependent patients.

Conclusions: Although EVAR is a minimally invasive procedure with substantially less physiologic stress than in open aortic repair, preoperative functional status is a critical determinant of adverse outcomes after EVAR in spite of the minimally invasive nature of the procedure. Functional status, as measured by performance of activities of daily living, can be used as a valuable marker of increased perioperative risk and may identify patients who may benefit from preoperative conditioning and specialized perioperative care.

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References

Lee J, He K, Harbaugh C, Schaubel D, Sonnenday C, Wang S . Frailty, core muscle size, and mortality in patients undergoing open abdominal aortic aneurysm repair. J Vasc Surg. 2011; 53(4):912-7. DOI: 10.1016/j.jvs.2010.10.111. View

Binder E, Schechtman K, Ehsani A, Steger-May K, Brown M, Sinacore D . Effects of exercise training on frailty in community-dwelling older adults: results of a randomized, controlled trial. J Am Geriatr Soc. 2002; 50(12):1921-8. DOI: 10.1046/j.1532-5415.2002.50601.x. View

Rockwood K, Fox R, Stolee P, Robertson D, Beattie B . Frailty in elderly people: an evolving concept. CMAJ. 1994; 150(4):489-95. PMC: 1486322. View

Hicks C, Wick E, Canner J, Black 3rd J, Arhuidese I, Qazi U . Hospital-Level Factors Associated With Mortality After Endovascular and Open Abdominal Aortic Aneurysm Repair. JAMA Surg. 2015; 150(7):632-6. DOI: 10.1001/jamasurg.2014.3871. View

Regensteiner J, Steiner J, Hiatt W . Exercise training improves functional status in patients with peripheral arterial disease. J Vasc Surg. 1996; 23(1):104-15. DOI: 10.1016/s0741-5214(05)80040-0. View

Prinssen M, Verhoeven E, Buth J, Cuypers P, van Sambeek M, Balm R . A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004; 351(16):1607-18. DOI: 10.1056/NEJMoa042002. View

Dasgupta M, Rolfson D, Stolee P, Borrie M, Speechley M . Frailty is associated with postoperative complications in older adults with medical problems. Arch Gerontol Geriatr. 2007; 48(1):78-83. DOI: 10.1016/j.archger.2007.10.007. View

Velanovich V, Antoine H, Swartz A, Peters D, Rubinfeld I . Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national database. J Surg Res. 2013; 183(1):104-10. DOI: 10.1016/j.jss.2013.01.021. View

Chaikof E, Brewster D, Dalman R, Makaroun M, Illig K, Sicard G . The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg. 2009; 50(4 Suppl):S2-49. DOI: 10.1016/j.jvs.2009.07.002. View

10.

Schermerhorn M, OMalley A, Jhaveri A, Cotterill P, Pomposelli F, Landon B . Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med. 2008; 358(5):464-74. DOI: 10.1056/NEJMoa0707348. View

11.

Swan B, Maislin G, Traber K . Symptom distress and functional status changes during the first seven days after ambulatory surgery. Anesth Analg. 1998; 86(4):739-45. DOI: 10.1097/00000539-199804000-00012. View

12.

Robinson T, Wu D, Pointer L, Dunn C, Cleveland Jr J, Moss M . Simple frailty score predicts postoperative complications across surgical specialties. Am J Surg. 2013; 206(4):544-50. PMC: 3788864. DOI: 10.1016/j.amjsurg.2013.03.012. View

13.

Hamel M, Henderson W, Khuri S, Daley J . Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc. 2005; 53(3):424-9. DOI: 10.1111/j.1532-5415.2005.53159.x. View

14.

Lachat M, Pecoraro F, Mayer D, Guillet C, Glenck M, Rancic Z . Outpatient endovascular aortic aneurysm repair: experience in 100 consecutive patients. Ann Surg. 2013; 258(5):754-8. DOI: 10.1097/SLA.0b013e3182a617f1. View

15.

Giles K, Pomposelli F, Hamdan A, Wyers M, Jhaveri A, Schermerhorn M . Decrease in total aneurysm-related deaths in the era of endovascular aneurysm repair. J Vasc Surg. 2009; 49(3):543-50. PMC: 2709247. DOI: 10.1016/j.jvs.2008.09.067. View

16.

Landefeld C, Palmer R, Kresevic D, Fortinsky R, Kowal J . A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. N Engl J Med. 1995; 332(20):1338-44. DOI: 10.1056/NEJM199505183322006. View

17.

Crawford R, Cambria R, Abularrage C, Conrad M, Lancaster R, Watkins M . Preoperative functional status predicts perioperative outcomes after infrainguinal bypass surgery. J Vasc Surg. 2010; 51(2):351-8. DOI: 10.1016/j.jvs.2009.08.065. View

18.

Dua A, Kuy S, Lee C, Upchurch Jr G, Desai S . Epidemiology of aortic aneurysm repair in the United States from 2000 to 2010. J Vasc Surg. 2014; 59(6):1512-7. DOI: 10.1016/j.jvs.2014.01.007. View

19.

Beffa L, Petroski G, Kruse R, Vogel T . Functional status of nursing home residents before and after abdominal aortic aneurysm repair. J Vasc Nurs. 2015; 33(3):106-11. PMC: 4707957. DOI: 10.1016/j.jvn.2015.02.003. View

20.

Gupta P, Franck C, Miller W, Gupta H, Forse R . Development and validation of a bariatric surgery morbidity risk calculator using the prospective, multicenter NSQIP dataset. J Am Coll Surg. 2011; 212(3):301-9. DOI: 10.1016/j.jamcollsurg.2010.11.003. View