IP031. Factors Affecting Mortality After Aortic Dissection Repair

Abstract

Thirty-day mortality rates after open and endovascular intervention for aortic dissection remain high. Increased understanding of preoperative comorbidities and factors that increase the risk of mortality can help guide patient, family, and provider decision-making. The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing open and endovascular repair of thoracic and abdominal aortic dissections between 2010 and 2015. Information about patients’ demographics, comorbidities, preoperative laboratory values, procedure details, and postoperative comorbidities was collected. Our goal was to determine features of the patients associated with 30-day mortality. SPSS (IBM Corp, Armonk, NY) was used to perform all univariate and multivariate analyses. We used Mann-Whitney and χ2 tests of significance for data analysis, and post hoc test was performed for power analysis. There were 411 patients who met the specified criteria, 364 who survived longer than 30 days postoperatively and 47 who died within 30 days of the intervention. Age, sex, and race were not significant determinants of survival after aortic dissection repair. In comparing those who survived beyond 30 days postoperatively and those who did not, preoperative ventilator dependence (odds ratio [OR]. 6.07; 95% confidence interval [CI], 1.8-19.9; P = .001) and a history of chronic obstructive pulmonary disease (OR 3.01; 95% CI, 1.5-5.9; P = .001) were predictive of mortality. Need for blood transfusion (OR, 5.92; 95% CI, 2.4-14.6; P = .001) and emergent operation status (OR, 6.57; 95% CI, 3.4-12.5; P = .001) were also predictive of 30-day mortality. Patients who did not survive 30 days postoperatively were more likely to have elevated preoperative blood urea nitrogen (P = .001) and creatinine (P = .001) levels and decreased hematocrit (P = .003). Multiple preoperative factors increase mortality risk after aortic dissection repair. The results of this study can help to optimize selection of patients and postoperative management, particularly in elective procedures.