Influence of Operative Time in the Results of Elective Endovascular Repair of Abdominal Aortic Aneurysms

Abstract

A prolonged operative time (OT) is a well-recognized risk factor of postoperative complications after many open surgical procedures, although little is known about its impact in less-invasive endovascular procedures. We aimed to define the characteristics related to a prolonged OT in the endovascular treatment of aorto-iliac aneurysms (EVAR) and to evaluate the influence of OT on postoperative outcomes. Retrospective analysis of 284 consecutive patients (mean age 75years, 95% male) who underwent an elective EVAR between 2000 and 2019. Operative characteristics related to OT and the impact of OT in postoperative results was studied using multiple lineal and logistic regression analyses, respectively. The mean surgical time was 200min. OT was associated (regression model) with the implantation of straight endografts (-38min, P=0.007), femoral artery surgery (+80min, P<0.001), hypogastric preservation procedures (+70min, P<0.001), associated peripheral arterial disease (+22min, P=0.013), general anesthesia (+34min, P<0.001), and aneurysm diameter (+9min/cm, P=0.002). During the postoperative period (<30days or at discharge), 21% presented a complication and 2.8% died. OT was independently associated with a higher incidence of postoperative complications (odds ratio [OR] for each additional 30' of surgery=1.34, P<0.001), such as immediate (OR=1.48, P=0.003) and 6-month mortality (OR=1.28, P=0.025). A prolonged OT is an independent risk factor for complications and mortality after EVAR. Surgeons must take this factor into consideration when defining the best therapeutic strategy for abdominal aortic aneurysms.