| Abstrakt: |
Certain complications following open repair of abdominal aortic aneurysms (AAAs) require additional operations or invasive procedures. The purpose of this study was to determine the effect of secondary interventions on mortality rate following open repair of intact and ruptured AAAs in the United States. Clinical data on 98,193 patients treated from 1988 to 2001 with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) primary procedure code 38.44 (resection of the abdominal aorta with replacement) were analyzed. Demographic factors, types of secondary interventions, and in-hospital mortality rates were assessed by univariate and multivariate logistic regression analysis (SPSS Version 11.0, Chicago, lL). The database utilized in this study was The Nationwide Inpatient Sample (NIS). The mortality rate was 4.5% in the intact MA group and 45.5% in the ruptured AAA group. The rate of secondary operations and procedures was much higher in the ruptured AAA group, especially related to renal failure (5.52% vs 1.49%, p <0.001); respiratory failure (3.67% vs 0.71 %, p <0.001); postoperative bleeding (2.41 % vs 0.81 %, p <0.001); or colonic ischemia (2.38% vs 0.36%, p <0.001). Increased mortality following open repair of intact AAAs accompanied: peripheral artery angioplasty/stenting (OR, 1.25; 95% CI, 1.04-1.51; p = 0.018); coronary artery angioplasty/stenting (OR, 1.68; 95% CI, 1.05-2.70; p = 0.031); inferior vena cava (IVC) filter placement (OR, 2.02; 95% Cl, 01.31-3.1; p = 0.001); vascular reconstruction or throm-boembolectomy (OR, 2.05; 95% CI, 1.9-2.22; p <0.001); lower extremity amputation (OR, 4.09; 95% Cl, 2.78-6.0; p<0.001); coronary artery bypass (OR, 6.71; 95% Cl, 3.74-12.03; p<0.001); operations for postoperative bleeding (OR, 6.92; 95% Cl, 5.7 1-8.4; p.<0.001); initiation of hemodialysis (OR, 10.52; 95% Cl, 9.22-12.01; p<0.001); tracheostomy (OR, 11.9; 95% CI, 9.86-14.37; p.<0.001); and colectomy (OR, 16.22; 95% Cl, 12.55-20.95; p<0.001). Increased risk of mortality following open repair of ruptured MM accompanied the following: operations for postoperative bleeding (OR, 1.5; 95% Cl, 1.22-1.85; p<0.001); colectomy (OR, 1.63; [ABSTRACT FROM AUTHOR] |
