Predictors of Operative Mortality of 928 Intact Aortoiliac Aneurysms

Abstract

The aim of this study is to identify preoperative and intraoperative factors associated with in-hospital mortality of intact abdominal aortoiliac aneurysm repair. In this observational study, prospectively collected information included demographics, risk factors, comorbidities, aneurysm characteristics (including special aneurysm presentation, i.e., inflammatory, mycotic/infected, aortocaval fistula), investigations, and operative variables. Receiver operating characteristic) curve analysis of the Glasgow aneurysm score (GAS) and the Vascular Study Group of New England (VSGNE) score was performed in the subgroup of bland aneurysms undergoing isolated elective repair. A total of 928 cases with intact aortoiliac aneurysms had an elective (n=882) or urgent (n=46) repair, associated with an in-hospital mortality of 1.7% and 8.7%, respectively (P=0.01). Open repair (n=514) was a predictor of higher mortality (3.3% vs. 0.5% for endovascular aneurysm repair [EVAR], n=414, odds ratio [OR] 7.1, P=0.003), and so was the pre-EVAR era (4.8% vs. 1.3% in the EVAR era, OR 4.0, P=0.004). Other significant predictors included the presence of abdominal/back pain (7.5% vs. 1.3%, OR=6.0, P=0.001), preoperative angiography (7% vs. 1.6%, OR=4.5, P=0.01), special aneurysm presentation (10.9% vs. 1.5%, OR=8.1, P<0.001), concomitant major procedures (19% vs. 1.7%, OR=14.0, P<0.001), serious intraoperative complications (9.1% vs. 1.5%, OR=6.6, P=0.001), median number of transfused units of blood intraoperatively (2 and 0 for cases with and without mortality, respectively, P<0.001), and procedure duration (270 and 150min for cases with and without mortality, respectively, P<0.001). Open repair (OR=4.5, P=0.05), special aneurysm presentation (OR=6.58, P=0.001), and concomitant major procedures (OR=14.3, P<0.001) were independent predictors of higher mortality. ROC curve analysis for the GAS (P=0.87) and VSGNE score (P=0.10) failed to demonstrate statistical significance in the subgroup of bland aneurysms undergoing isolated elective repair. Our study has demonstrated independent risk factors for mortality, which should be considered when contemplating aortoiliac aneurysm repair. We failed to externally validate the GAS and VSGNE score.