HHS Public Access Author manuscript Author Manuscript
J Vasc Surg. Author manuscript; available in PMC 2017 August 01. Published in final edited form as: J Vasc Surg. 2016 August ; 64(2): 297–305. doi:10.1016/j.jvs.2016.02.055.
Outcomes for Symptomatic Abdominal Aortic Aneurysms in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Peter A. Soden1, Sara L. Zettervall1,2, Klaas H.J. Ultee1, Jeremy D. Darling1, Dominique B. Buck1, Chantel N. Hile1,3, Allen D. Hamdan1, and Marc L. Schermerhorn1
Author Manuscript
1Division
of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 2Division
of Surgery, George Washington University, Washington, DC
3Division
of Vascular and Endovascular Surgery, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
Abstract
Author Manuscript
Introduction—Historically symptomatic AAAs were found to have intermediate mortality compared to asymptomatic and ruptured AAAs but, with wider EVAR use, a more recent study suggested mortality of symptomatic aneurysms were similar to asymptomatic AAAs. These prior studies were limited by small numbers. The purpose of this study is to evaluate the mortality and morbidity associated with symptomatic AAA repair in a large contemporary population. Methods—All patients undergoing infrarenal AAA repair were identified in the 2011–2013 ACS-NSQIP, Vascular Surgery targeted module. We excluded acute conversions to open repair and those for whom the surgical indication was embolization, dissection, thrombosis, or not documented. We compared 30-day mortality and major adverse events (MAE) for asymptomatic, symptomatic, and ruptured AAA repair, stratified by EVAR and open repair, with univariate analysis and multivariable logistic regression.
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Results—5502 infrarenal AAAs were identified, 4495 asymptomatic (830 open repair, 3665 [82%] EVAR), 455 symptomatic (143 open, 312 [69%] EVAR), and 552 ruptured aneurysms (263 open, 289 [52%] EVAR). Aneurysm diameter was similar between asymptomatic and symptomatic AAAs, when stratified by procedure type, but larger for ruptured aneurysms (EVAR symptomatic 5.8cm ±1.6 vs. ruptured 7.5cm ±2.0, P1.78 mg/dla
23
(1097)
24
ASA class > III
5.8
(127)
2.8
Dependent functional status
Aneurysm Diameter, cm (mean, SD)
(75)
CHF exacerbation
Prior Open Abd. Surgery
(837)
19 1.7
Severe COPD
History of
(851)
19
(1408)
32
Obesity (BMI >30)
0.1
(1423)
32
Current Smoker
Preoperative Intubation
(710)
Dyspnea at rest or exertion
(3604)
16
(3887)
87 80
±8.6
73.6
Diabetes
(3665)
4495 82
Male
White
Age (years, mean ±SD)
EVAR
N
.19
.045
.39