Postoperative Renal Complications Adversely Impact Late Survival Following Open Juxtarenal Aortic Aneurysm Repair

Abstract

Preoperative renal function is a predictor of morbidity and mortality after the repair of juxtarenal aortic aneurysms. However, the impact of postoperative renal failure on late outcomes after repair are poorly understood. Therefore, our objective was to assess the impact of postoperative renal dysfunction on long-term outcomes after juxtarenal aortic aneurysm repair. We identified all open repairs of juxtarenal aortic aneurysms in the Vascular Quality Initiative from 2011 to 2018 with linkage to Medicare claims data. Juxtarenal aortic aneurysm repair was defined as the placement of proximal clamp above at least one renal artery during open repair. Postoperative renal function was categorized as stable renal function, acute kidney injury (AKI; ≥0.5 mg/dL serum creatinine increase) or new renal replacement therapy (RRT). Kaplan-Meier estimates and Cox regression were used to identify the effect of AKI or RRT on 5-year mortality, rupture, and reintervention. Of 1643 open repairs, 29% experienced postoperative AKI, and 6.5% required RRT. Renal visceral ischemia time >25 minutes was higher in the AKI and RRT cohorts (stable: 52% vs AKI 65% vs RRT 67%; P < .001). Postoperative mortality was higher with increasing severity of postoperative renal dysfunction (2.5% vs 9.5% vs 31%; P < .001). Increasing renal dysfunction severity was also associated with higher risk of 5-year mortality (14% vs 25% vs 57%; AKI: adjusted hazard ratio [aHR], 1.7 [1.3-2.4]; P < .001/RRT: aHR, 4.6 [3.1-7.0]; P < .001) (Fig). In addition, RRT was associated with higher risk of late rupture (3.1% vs 6.8% vs 10%; AKI: aHR, 1.1 [0.3-3.7]; P < .788/RRT: aHR, 5.5 [1.2-25]; P < .026) and late reintervention (15% vs 20% vs 55%; AKI: aHR, 1.4 [0.9-2.2]; P = .114/RRT: aHR, 3.4 [1.7-7.0]; P = .001). Postoperative renal dysfunction adversely impacts late mortality, rupture, and reintervention. In addition increasing severity of postoperative renal dysfunction has a dose-dependent effect on perioperative and late outcomes after repair. Preoperative and intraoperative care should be taken to prevent renal complications after repair. Furthermore, these patients may benefit from closer follow-up after repair.