Contemporary outcomes of open thoracoabdominal aneurysm repair: functional status is the strongest predictor of perioperative mortality

Tammam Obeid, Caitlin Hicks, Kanhua Yin, Iisbor Arhuidese, Besma Nejim, Arman Kilic, James Hamilton Black, Mahmoud Malas

Research output: Contribution to journalArticle

Abstract

Background Open repair of thoracoabdominal and descending thoracic aneurysm (TAA) carries significant operative morbidity and mortality. Despite evolving operative techniques patient-level risk factors affecting mortality after open TAA repair, including patient functional status, remain to be fully understood. Materials and methods We identified all open TAA repair cases in the National Surgical Quality Improvement Program database between 2005 and 2013. Multivariable logistic regression was used to evaluate the effect of patients' age, gender, race, body mass index (BMI), comorbid conditions, functional status, ASA class, smoking, rupture, descending thoracic aneurysm versus Crawford types, dissection, and preoperative: transfusion, creatinine levels, on perioperative (30-d) mortality after open TAA repair. Results A total of 1048 patients underwent open TAA repair during the 9-y study period. Mean patient age was (mean ± SEM) 67 ± 0.4 y, mean BMI was 27 ± 6 kg m2, and most patients (60%) were male. Perioperative mortality was 14.0% (nonruptured 11.4% versus ruptured 34.2%, P < 0.01) and patients with postoperative renal failure requiring dialysis comprised 12.6%. On multivariable analysis, dependent status had the highest effect on operative mortality, tripling the risk of death (odds ratio [OR] = 3.18, 95% confidence interval [CI] = 1.49-6.81, P < 0.01). Ruptured aneurysms had more than double the operative mortality risk (OR = 2.49, 95% CI = 1.42-4.38, P < 0.01). Preoperative renal insufficiency added 23% mortality risk per unit increase in creatinine (OR = 1.23, 95% CI = 1.01-1.50, P = 0.04), whereas each year in patient age or unit increase in BMI increased the risk of death by 4% (OR = 1.04, 95% CI = 1.02-1.07, P < 0.01, OR = 1.04, 95% CI = 1.00-1.07, P = 0.04, respectively). Conclusions Patients' functional status is the strongest independent predictor of perioperative death. Other patient-level factors, including increasing age, BMI, and renal dysfunction, also play a role. Appropriate patient selection for open TAA repair is essential for achieving good outcomes.

Original languageEnglish (US)
Pages (from-to)9-15
Number of pages7
JournalJournal of Surgical Research
Volume206
Issue number1
DOIs
StatePublished - Nov 1 2016

Fingerprint

Aneurysm
Mortality
Thorax
Odds Ratio
Confidence Intervals
Body Mass Index
Renal Insufficiency
Creatinine
Ruptured Aneurysm
Quality Improvement
Patient Selection
Dissection
Rupture
Dialysis
Logistic Models
Smoking
Databases
Morbidity
Kidney

Keywords

  • Aneurysm
  • DTA
  • Functional status
  • Mortality
  • Open repair
  • Thoracoabdominal

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Contemporary outcomes of open thoracoabdominal aneurysm repair : functional status is the strongest predictor of perioperative mortality. / Obeid, Tammam; Hicks, Caitlin; Yin, Kanhua; Arhuidese, Iisbor; Nejim, Besma; Kilic, Arman; Black, James Hamilton; Malas, Mahmoud.

In: Journal of Surgical Research, Vol. 206, No. 1, 01.11.2016, p. 9-15.

Research output: Contribution to journalArticle

Obeid, Tammam ; Hicks, Caitlin ; Yin, Kanhua ; Arhuidese, Iisbor ; Nejim, Besma ; Kilic, Arman ; Black, James Hamilton ; Malas, Mahmoud. / Contemporary outcomes of open thoracoabdominal aneurysm repair : functional status is the strongest predictor of perioperative mortality. In: Journal of Surgical Research. 2016 ; Vol. 206, No. 1. pp. 9-15.
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abstract = "Background Open repair of thoracoabdominal and descending thoracic aneurysm (TAA) carries significant operative morbidity and mortality. Despite evolving operative techniques patient-level risk factors affecting mortality after open TAA repair, including patient functional status, remain to be fully understood. Materials and methods We identified all open TAA repair cases in the National Surgical Quality Improvement Program database between 2005 and 2013. Multivariable logistic regression was used to evaluate the effect of patients' age, gender, race, body mass index (BMI), comorbid conditions, functional status, ASA class, smoking, rupture, descending thoracic aneurysm versus Crawford types, dissection, and preoperative: transfusion, creatinine levels, on perioperative (30-d) mortality after open TAA repair. Results A total of 1048 patients underwent open TAA repair during the 9-y study period. Mean patient age was (mean ± SEM) 67 ± 0.4 y, mean BMI was 27 ± 6 kg m2, and most patients (60{\%}) were male. Perioperative mortality was 14.0{\%} (nonruptured 11.4{\%} versus ruptured 34.2{\%}, P < 0.01) and patients with postoperative renal failure requiring dialysis comprised 12.6{\%}. On multivariable analysis, dependent status had the highest effect on operative mortality, tripling the risk of death (odds ratio [OR] = 3.18, 95{\%} confidence interval [CI] = 1.49-6.81, P < 0.01). Ruptured aneurysms had more than double the operative mortality risk (OR = 2.49, 95{\%} CI = 1.42-4.38, P < 0.01). Preoperative renal insufficiency added 23{\%} mortality risk per unit increase in creatinine (OR = 1.23, 95{\%} CI = 1.01-1.50, P = 0.04), whereas each year in patient age or unit increase in BMI increased the risk of death by 4{\%} (OR = 1.04, 95{\%} CI = 1.02-1.07, P < 0.01, OR = 1.04, 95{\%} CI = 1.00-1.07, P = 0.04, respectively). Conclusions Patients' functional status is the strongest independent predictor of perioperative death. Other patient-level factors, including increasing age, BMI, and renal dysfunction, also play a role. Appropriate patient selection for open TAA repair is essential for achieving good outcomes.",
keywords = "Aneurysm, DTA, Functional status, Mortality, Open repair, Thoracoabdominal",
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T1 - Contemporary outcomes of open thoracoabdominal aneurysm repair

T2 - functional status is the strongest predictor of perioperative mortality

AU - Obeid, Tammam

AU - Hicks, Caitlin

AU - Yin, Kanhua

AU - Arhuidese, Iisbor

AU - Nejim, Besma

AU - Kilic, Arman

AU - Black, James Hamilton

AU - Malas, Mahmoud

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Background Open repair of thoracoabdominal and descending thoracic aneurysm (TAA) carries significant operative morbidity and mortality. Despite evolving operative techniques patient-level risk factors affecting mortality after open TAA repair, including patient functional status, remain to be fully understood. Materials and methods We identified all open TAA repair cases in the National Surgical Quality Improvement Program database between 2005 and 2013. Multivariable logistic regression was used to evaluate the effect of patients' age, gender, race, body mass index (BMI), comorbid conditions, functional status, ASA class, smoking, rupture, descending thoracic aneurysm versus Crawford types, dissection, and preoperative: transfusion, creatinine levels, on perioperative (30-d) mortality after open TAA repair. Results A total of 1048 patients underwent open TAA repair during the 9-y study period. Mean patient age was (mean ± SEM) 67 ± 0.4 y, mean BMI was 27 ± 6 kg m2, and most patients (60%) were male. Perioperative mortality was 14.0% (nonruptured 11.4% versus ruptured 34.2%, P < 0.01) and patients with postoperative renal failure requiring dialysis comprised 12.6%. On multivariable analysis, dependent status had the highest effect on operative mortality, tripling the risk of death (odds ratio [OR] = 3.18, 95% confidence interval [CI] = 1.49-6.81, P < 0.01). Ruptured aneurysms had more than double the operative mortality risk (OR = 2.49, 95% CI = 1.42-4.38, P < 0.01). Preoperative renal insufficiency added 23% mortality risk per unit increase in creatinine (OR = 1.23, 95% CI = 1.01-1.50, P = 0.04), whereas each year in patient age or unit increase in BMI increased the risk of death by 4% (OR = 1.04, 95% CI = 1.02-1.07, P < 0.01, OR = 1.04, 95% CI = 1.00-1.07, P = 0.04, respectively). Conclusions Patients' functional status is the strongest independent predictor of perioperative death. Other patient-level factors, including increasing age, BMI, and renal dysfunction, also play a role. Appropriate patient selection for open TAA repair is essential for achieving good outcomes.

AB - Background Open repair of thoracoabdominal and descending thoracic aneurysm (TAA) carries significant operative morbidity and mortality. Despite evolving operative techniques patient-level risk factors affecting mortality after open TAA repair, including patient functional status, remain to be fully understood. Materials and methods We identified all open TAA repair cases in the National Surgical Quality Improvement Program database between 2005 and 2013. Multivariable logistic regression was used to evaluate the effect of patients' age, gender, race, body mass index (BMI), comorbid conditions, functional status, ASA class, smoking, rupture, descending thoracic aneurysm versus Crawford types, dissection, and preoperative: transfusion, creatinine levels, on perioperative (30-d) mortality after open TAA repair. Results A total of 1048 patients underwent open TAA repair during the 9-y study period. Mean patient age was (mean ± SEM) 67 ± 0.4 y, mean BMI was 27 ± 6 kg m2, and most patients (60%) were male. Perioperative mortality was 14.0% (nonruptured 11.4% versus ruptured 34.2%, P < 0.01) and patients with postoperative renal failure requiring dialysis comprised 12.6%. On multivariable analysis, dependent status had the highest effect on operative mortality, tripling the risk of death (odds ratio [OR] = 3.18, 95% confidence interval [CI] = 1.49-6.81, P < 0.01). Ruptured aneurysms had more than double the operative mortality risk (OR = 2.49, 95% CI = 1.42-4.38, P < 0.01). Preoperative renal insufficiency added 23% mortality risk per unit increase in creatinine (OR = 1.23, 95% CI = 1.01-1.50, P = 0.04), whereas each year in patient age or unit increase in BMI increased the risk of death by 4% (OR = 1.04, 95% CI = 1.02-1.07, P < 0.01, OR = 1.04, 95% CI = 1.00-1.07, P = 0.04, respectively). Conclusions Patients' functional status is the strongest independent predictor of perioperative death. Other patient-level factors, including increasing age, BMI, and renal dysfunction, also play a role. Appropriate patient selection for open TAA repair is essential for achieving good outcomes.

KW - Aneurysm

KW - DTA

KW - Functional status

KW - Mortality

KW - Open repair

KW - Thoracoabdominal

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