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Rao A, Mehta A, Lazar AN, Siracuse J, Garg K, Schermerhorn M, Takayama H, Patel VI. The Association Between Preoperative Independent Ambulatory Status and Outcomes After Open Abdominal Aortic Aneurysm Repairs. Ann Vasc Surg 2021; 81:70-78. [PMID: 34785339 DOI: 10.1016/j.avsg.2021.10.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Preoperative functional status is appreciated as a key determinant of decision-making when evaluating patients for complex elective surgeries. We used the Vascular Quality Initiative (VQI) to analyze the effect of being able to independently ambulate on outcomes after open abdominal aortic aneurysm (AAA) repairs. METHODS We identified all patients who underwent elective or urgent open AAA repairs from January 2013 to August 2019 in the VQI registry. We recorded demographic variables, comorbidities, and operative factors such as approach, operative ischemia time, proximal clamp site, and presence of iliac aneurysms. Short-term and long-term outcomes included 30-day mortality, any perioperative complications, failure to rescue (defined as death after a complication), and one-year all-cause mortality. We dichotomized patients based on their ability to independently ambulate (Ambulatory) or inability to ambulate independently (Non-Ambulatory) and used both multivariable logistic regressions and cox-proportional hazards models to evaluate outcomes. RESULTS Of 5,371 patients, 328 (6.1%) could not ambulate independently and were more likely to be older (median age 69 vs 72), female (25% vs. 38%), and have greater comorbidities. Overall outcomes were: 4.3% for 30-day mortality, 38.7% for complications, 10.2% for failure-to-rescue, and 6.9% for one-year mortality. Univariate analysis showed higher rates of all adverse outcomes in non-ambulatory patients. On adjusted analysis, non-ambulatory patients had increased odds of complications by 46% (OR 1.46 [95%-CI 1.11-1.91]) and one-year mortality by 46% (HR 1.46 [95%-CI 1.06-1.99]), but not failure to rescue (OR 1.05 [95%-CI 0.67-1.62]) or 30-day mortality (OR 1.22 [95%-CI 0.82-1.81]). Increased hospital volume, age, and increased operative renal ischemia time were independently associated with adverse outcomes. CONCLUSIONS Non-ambulatory status was observed in a small percentage of patients undergoing open AAA repair but was associated with higher rates of post-operative complications and one-year mortality. Ambulatory capacity is one of the key determinants of outcomes following open AAA repair. In patients with poor ambulatory function, a conservative approach is highly recommended over invasive open surgical intervention.
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Affiliation(s)
- Abhishek Rao
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, 10032 (USA)
| | - Ambar Mehta
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, 10032 (USA)
| | - Andrew N Lazar
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, 10032 (USA).
| | - Jeffrey Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, 732 Harrison Avenue, 3(rd) Floor, Boston, MA, 02118 (USA)
| | - Karan Garg
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University, 530 1(st) Avenue, 11(th) Floor, New York, NY, 10016 (USA)
| | - Marc Schermerhorn
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, STE 5B, Boston, MA, 02215 (USA)
| | - Hiroo Takayama
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, 10032 (USA)
| | - Virendra I Patel
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, 10032 (USA)
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