Colonic ischemia complicating open vs endovascular abdominal aortic aneurysm repair
Autor: | Matthew J. Eckert, Robert Jason T. Perry, Matthew J. Martin, Vance Y. Sohn, Scott R. Steele |
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Jazyk: | angličtina |
Předmět: |
Male
medicine.medical_treatment Aneurysm Ruptured Logistic regression Endovascular aneurysm repair Severity of Illness Index Cohort Studies Aortic aneurysm Postoperative Complications Odds Ratio Medicine Hospital Mortality Registries Aged 80 and over Incidence (epidemiology) Incidence Middle Aged Abdominal aortic aneurysm Thoracotomy Anesthesia cardiovascular system Female Cardiology and Cardiovascular Medicine Colitis Ischemic medicine.medical_specialty Ischemia Risk Assessment Statistics Nonparametric Blood Vessel Prosthesis Implantation Aneurysm Age Distribution Predictive Value of Tests Confidence Intervals Humans cardiovascular diseases Sex Distribution Aged Probability Analysis of Variance business.industry Angioplasty medicine.disease Survival Analysis Surgery Logistic Models business Complication Aortic Aneurysm Abdominal Follow-Up Studies |
Zdroj: | Journal of Vascular Surgery. (2):272-277 |
ISSN: | 0741-5214 |
DOI: | 10.1016/j.jvs.2008.03.040 |
Popis: | ObjectiveColonic ischemia (CI) is a known complication of both open abdominal aortic aneurysm (AAA) repair and endovascular aneurysm repair (EVAR). Despite a relatively low incidence of 1% to 6%, the associated morbidity and mortality are high. We sought to analyze factors that affect the development of CI on the basis of type of repair as well as associated outcomes from a large nationwide database.MethodsAll admissions undergoing AAA repair were selected from the 2003 and 2004 Nationwide Inpatient Sample. Univariate and logistic regression analyses were used to compare outcome measures and identify independent predictors of development of colonic ischemic complications.ResultsWe identified 89,967 admissions for AAA repair (mean age, 69.9 years). Open elective repair was performed in 49% of cases, elective EVAR in 41%, and ruptured aneurysm repair in 9%. The overall incidence of CI was 2.2% (1941 cases); however, the incidence for specific procedures was significantly higher after repair of ruptured aneurysm (8.9%) and open elective repair (1.9%) than after EVAR (0.5%; both P < .001). Patients who developed CI were at increased risk for mortality (37.8% vs 6.7%), had longer hospital stays (21.5 vs 8.1 days), incurred higher hospital charges ($182,000 vs $77,000), and were less likely to be discharged home from hospital (36% vs 71%; all P < .001). Independent predictors of development of CI included ruptured aneurysm (odds ratio [OR] = 6.4), female gender (OR = 1.6) and, in the setting of elective repair, open operation (OR = 3.1). CI was found to be a strong independent predictor of mortality in evaluations of both the entire cohort (OR = 4.5) and the elective open repair and EVAR (OR = 2.4) subgroups.ConclusionsCI is significantly more common after open AAA repair and is associated with increased morbidity and a two- to fourfold increase in mortality. |
Databáze: | OpenAIRE |
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