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
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