Department of Surgery, University of Missouri, Columbia, MO.
School of Medicine, University of Missouri, Columbia, MO.
J Vasc Surg. 2022 Aug;76(2):428-436. doi: 10.1016/j.jvs.2022.01.140. Epub 2022 Feb 25.
Elective abdominal aortic aneurysm (AAA) repair for patients with a diagnosis of cancer has remained controversial. In the present study, we evaluated the in-hospital outcomes for patients who had undergone AAA repair in the setting of a cancer diagnosis.
Inpatients (2008-2018) who had undergone elective AAA repair were selected from the Cerner Health Facts database using International Classification of Diseases, ninth and tenth revision, procedure codes. We used χ analysis and logistic regression models to evaluate the association of patient characteristics with the medical and vascular outcomes.
A total of 8663 patients who had undergone AAA repair were identified (270 with a cancer diagnosis and 8393 without a cancer diagnosis). No significant demographic differences were found between the two groups, except that more patients with a cancer diagnosis had undergone endovascular aneurysm repair (EVAR) than open aneurysm repair (88.2% vs 82.1%; P = .01). Male reproductive organ (24.8%) and lung (24.4%) cancer were the most common cancer diagnoses in the cohort. The unadjusted analysis revealed that patients with a cancer diagnosis were more likely to require remedial EVAR (relative risk, 3.47; 95% confidence interval [CI], 1.18-10.2) or reoperation for bleeding, infection, or thrombosis (relative risk, 1.59; 95% CI, 1.09-2.32). Multivariable analysis demonstrated that, overall, patients with a cancer diagnosis were more likely to require a prolonged length of stay (odds ratio [OR], 2.2; 95% CI, 1.5-3.3) and to have developed respiratory failure (OR, 2.1; 95% CI, 1.3-3.4) or infection (OR, 1.7; 95% CI, 1.2-2.4). Similar point estimates were found for men with and without a cancer diagnosis. However, women with a cancer diagnosis had a greater odds of a prolonged length of stay compared with women without a cancer diagnosis (OR, 2.6; 95% CI, 1.2-5.6). EVAR in the presence of a cancer diagnosis was also significantly associated with poor outcomes.
Elective AAA repair for patients with a cancer diagnosis was associated with a prolonged length of stay and the development of infection, respiratory failure, and vascular-specific complications during the inpatient hospitalization. Given that differences in outcomes stratified by gender and treatment modality have been shown for patients with a cancer diagnosis, careful patient selection is important and reinforces the finding that cancer exerts negative systemic postoperative effects even when treated or quiescent.
对诊断为癌症的患者进行择期腹主动脉瘤（AAA）修复一直存在争议。本研究评估了诊断为癌症的患者行 AAA 修复的住院期间结局。
使用国际疾病分类第 9 版和第 10 版的程序代码，从 Cerner Health Facts 数据库中选择 2008 年至 2018 年期间接受择期 AAA 修复的住院患者。我们使用卡方检验和逻辑回归模型评估患者特征与医疗和血管结局的关联。
共确定了 8663 名接受 AAA 修复的患者（270 名诊断为癌症，8393 名无癌症诊断）。两组之间除了接受血管内动脉瘤修复（EVAR）的患者比例（88.2% vs 82.1%；P =.01）高于接受开放动脉瘤修复的患者外，无明显的人口统计学差异。男性生殖器官（24.8%）和肺部（24.4%）癌症是该队列中最常见的癌症诊断。未调整分析显示，诊断为癌症的患者更有可能需要补救性 EVAR（相对风险，3.47；95%置信区间[CI]，1.18-10.2）或因出血、感染或血栓形成而再次手术（相对风险，1.59；95% CI，1.09-2.32）。多变量分析表明，总体而言，诊断为癌症的患者更有可能需要延长住院时间（优势比[OR]，2.2；95% CI，1.5-3.3），并且更有可能发生呼吸衰竭（OR，2.1；95% CI，1.3-3.4）或感染（OR，1.7；95% CI，1.2-2.4）。在有或没有癌症诊断的男性中，也发现了相似的点估计值。然而，与无癌症诊断的女性相比，有癌症诊断的女性的住院时间延长的可能性更大（OR，2.6；95% CI，1.2-5.6）。有癌症诊断的 EVAR 也与不良结局显著相关。
诊断为癌症的患者行择期 AAA 修复与住院期间住院时间延长以及感染、呼吸衰竭和血管特定并发症的发生相关。鉴于已经显示出患有癌症的患者在性别和治疗方式方面的结局存在差异，因此仔细选择患者很重要，并证实了即使得到治疗或处于静止状态，癌症也会对术后系统产生负面影响。
