IP011. Factors Associated With Postoperative Renal Dysfunction and the Subsequent Impact on Survival After Open Juxtarenal Abdominal Aortic Aneurysm Repair

Abstract

Renal dysfunction is a well-described complication of open juxtarenal abdominal aortic aneurysm repair; however, the associated risk factors and corresponding impact on survival are not well described. We identified all patients not on hemodialysis (HD) undergoing open repair of nonruptured juxtarenal aneurysms in the Vascular Quality Initiative from 2003 to 2017. We used mixed effects logistic regression to determine factors associated with in-hospital acute kidney injury (AKI; defined as serum creatinine increase >0.5 mg/dL) and dialysis as well as the association between postoperative renal function and perioperative mortality. Cox regression was used to determine the association between postoperative renal complications and long-term survival. We identified 2635 open juxtarenal repairs, of which 621 (24%) were complicated by AKI. The majority of these (20% of the overall cohort) were AKI alone, but 2.2% required temporary HD and 1.7% were permanently dialysis dependent. Factors independently associated with postoperative renal dysfunction included renal-visceral ischemia time (per minute: odds ratio [OR], 1.01 [1.01-1.02]; P < .001), clamp site (above both renal arteries: OR, 1.4 [1.1-1.8; P = .02]; supraceliac: OR, 1.7 [1.1-2.5; P = .01]), statin use (OR, 1.5 [1.1-2.0]; P = .01), male sex (OR, 1.7 [1.2-2.2]; P = .002), and preoperative renal function (glomerular filtration rate [GFR] 45-60 mL/min/1.73 m2: OR, 1.8 [1.3-2.5; P < .001]; GFR 30-45 mL/min/1.73 m2: OR, 1.9 [1.2-2.8; P = .003]; GFR <30 mL/min/1.73 m2: OR, 8.0 [3.8-16.7; P < .001]). When renal-visceral ischemia time was categorized, there was no difference in risk of postoperative renal dysfunction until >25 minutes, but risk increased stepwise thereafter (25-39 minutes: OR, 1.6 [1.2-2.1; P = .004]; 40+ minutes: OR, 2.6 [1.9-3.5; P < .001]). Neither mannitol nor the use of cold renal perfusion was associated with renal complications or mortality in the overall cohort or in the subset of patients with clamp times >25 minutes. Postoperative renal dysfunction was associated with higher adjusted perioperative mortality (AKI: OR, 2.6 [1.4-5.0; P < .01]; HD: OR, 10.5 [4.0-27.6; P < .001]) and significantly higher risk of long-term mortality (AKI: hazard ratio, 1.5 [1.0-2.1; P = .049]; HD: hazard ratio, 5.8 [3.2-10.3; P < .001]; Fig). Although multiple patient and intraoperative factors are associated with postoperative renal dysfunction after open juxtarenal repair, the use of mannitol and cold renal perfusion were not. Postoperative renal dysfunction, even a mild elevation in creatinine concentration, is associated with higher perioperative and long-term mortality.