编辑精选 - 择期开放修复复杂腹主动脉瘤后死亡率较高。
Editor's Choice - Mortality is High Following Elective Open Repair of Complex Abdominal Aortic Aneurysms.
机构信息
Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA.
Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA.
出版信息
Eur J Vasc Endovasc Surg. 2021 Jan;61(1):90-97. doi: 10.1016/j.ejvs.2020.09.002. Epub 2020 Oct 9.
OBJECTIVE
To evaluate the 30 day mortality of elective open complex abdominal aortic aneurysm (cAAA) repair and identify factors associated with death.
METHODS
This was a retrospective cohort study using a Targeted Vascular Module from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). All patients undergoing elective repair for juxta- and suprarenal abdominal aortic aneurysm (AAA), or type IV thoraco-abdominal aneurysms (TAAA) from 2011 to 2017 were identified. Thirty day mortality and complication rates for open repair were established. A comparison endovascular aneurysm repair (EVAR) group was extracted from the same time period, and inverse probability weighting was applied for comparison. Logistic regression was used to identify factors independently associated with open repair mortality.
RESULTS
Of the 957 patients who underwent an elective open cAAA repair over the study period, 65 (6.8%) died. The mean age of the patient was 71.3 ± 8.0 years. The distribution by aneurysm type was 605 juxtarenal AAA (28 deaths, 4.6%); 284 suprarenal AAA (16 deaths, 9.5%), and 68 type IV TAAA (10 deaths, 14.7%). During the same time period, there were 1149 endovascular repairs for cAAA, with 43 deaths (3.7%). After inverse probability weighting and weighted logistic regression, open repair 30 day mortality yielded an OR 1.9, 95% CI 1.2-3.1, p = .01 compared with EVAR. Factors independently associated with death included more proximal extent aneurysm (referent [ref]: juxtarenal: OR 2.0 per extent increase, 95% CI 1.4-3.0, p < .001), BMI < 18.5 (OR 4.0, 95% CI 1.6-10.1, p = .003), history of severe chronic obstructive pulmonary disease (COPD) (OR 2.6, 95% CI 1.5-4.4, p = .001), more severe chronic kidney disease (CKD) (ref: none/mild): OR 1.9, 95% CI 1.2-2.8, p = .004), and age (OR 1.06/year, 95% CI 1.02-1.09, p = .002.
CONCLUSION
The 30 day mortality was 4.6% for juxtarenal AAA, 9.5% for suprarenal AAA, and 14.7% for type IV TAAA. The open repair odds of 30 day mortality was nearly twice that of endovascular repair for cAAA. Independent associations with death included BMI <18.5, more severe CKD level, more proximally extending aneurysm, age, and history of advanced COPD.
目的
评估择期开放复杂腹主动脉瘤（cAAA）修复的 30 天死亡率，并确定与死亡相关的因素。
方法
这是一项使用美国外科医师学院的靶向血管模块（Targeted Vascular Module）进行的回顾性队列研究，来自国家外科质量改进计划（NSQIP）。从 2011 年至 2017 年，确定了所有接受择期修复肾下和肾上腹主动脉瘤（AAA）或 IV 型胸腹主动脉瘤（TAAA）的患者。确定了开放修复的 30 天死亡率和并发症发生率。从同一时期提取了血管内动脉瘤修复（EVAR）组，并进行了逆概率加权比较。使用逻辑回归确定与开放修复死亡率相关的独立因素。
结果
在研究期间，957 名接受择期开放 cAAA 修复的患者中，有 65 人（6.8%）死亡。患者的平均年龄为 71.3±8.0 岁。动脉瘤类型分布为 605 例肾下 AAA（28 例死亡，4.6%）；284 例肾上 AAA（16 例死亡，9.5%）和 68 例 IV 型 TAAA（10 例死亡，14.7%）。同期，有 1149 例 cAAA 行血管内修复，有 43 例死亡（3.7%）。经过逆概率加权和加权逻辑回归后，开放修复 30 天死亡率的 OR 为 1.9，95%CI 为 1.2-3.1，p<.001，与 EVAR 相比。与死亡相关的独立因素包括更靠近近端的动脉瘤范围（参考：肾下：每增加 1 个范围，OR 为 2.0，95%CI 为 1.4-3.0，p<.001），BMI<18.5（OR 为 4.0，95%CI 为 1.6-10.1，p=.003），严重慢性阻塞性肺疾病（COPD）病史（OR 为 2.6，95%CI 为 1.5-4.4，p=.001），更严重的慢性肾脏病（CKD）（参考：无/轻度：OR 为 1.9，95%CI 为 1.2-2.8，p=.004）和年龄（OR 为 1.06/年，95%CI 为 1.02-1.09，p=.002）。
结论
肾下 AAA 的 30 天死亡率为 4.6%，肾上 AAA 为 9.5%，IV 型 TAAA 为 14.7%。与 cAAA 的血管内修复相比，开放修复的 30 天死亡率的 OR 接近两倍。与死亡相关的独立关联因素包括 BMI<18.5、更严重的 CKD 水平、更靠近近端的动脉瘤、年龄和严重 COPD 病史。
Zotero 插件