DiBartolomeo Alexander D, Ding Li, Han Sukgu M, Weaver Fred A, Magee Gregory A
Division of Vascular Surgery and Endovascular Therapy, Keck Medical Center of University of Southern California, Los Angeles, CA.
Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Ann Vasc Surg. 2025 May;114:133-143. doi: 10.1016/j.avsg.2024.12.080. Epub 2025 Jan 23.
This study assessed the association between chronic obstructive pulmonary disease (COPD) severity and postoperative mortality among patients undergoing thoracic endovascular aortic repair (TEVAR) and complex endovascular aortic repair (CEVAR).
A retrospective review of the Vascular Quality Initiative database identified elective TEVAR and CEVAR cases from 2013 to 2022, with endograft proximal landing zone ≥2 for thoracic or complex abdominal aortic disease. Symptomatic diseases, ruptures, and urgent or emergent surgeries were excluded. Patients were stratified by COPD severity. The primary outcome was in-hospital mortality. Secondary outcomes included respiratory complications and 1-year mortality. Multivariable logistic regression was used for in-hospital mortality, respiratory complications, and 1-year mortality.
Among 11,336 patients with TEVAR and CEVAR, 66% did not have COPD, 9% had COPD not on medications, 20% had COPD on medications, and 6% had COPD on home supplemental oxygen. In-hospital mortality was 2.3%, 3.7%, 3.2%, and 4.5% (P = 0.0004) respectively, and was not associated with increased odds of mortality. Respiratory complications occurred in 4.3%, 4.5%, 6.4%, and 7.3% (P < 0.0001) and were associated with increased odds for COPD on medications (OR 1.3) and COPD on home supplemental oxygen (OR 1.7). 1-year survival was 91%, 87%, 86%, and 80% and associated with increased risk for each COPD group (HR 1.4, HR 1.4, HR 1.9).
Patients with COPD undergoing TEVAR and CEVAR have increased rates of in-hospital mortality, respiratory complications, and 1-year mortality. COPD severity is independently associated with increased respiratory complications and 1-year mortality, which should be factored into preoperative decision-making.
本研究评估了接受胸主动脉腔内修复术（TEVAR）和复杂主动脉腔内修复术（CEVAR）的患者中，慢性阻塞性肺疾病（COPD）严重程度与术后死亡率之间的关联。
对血管质量倡议数据库进行回顾性分析，确定了2013年至2022年期间接受择期TEVAR和CEVAR手术的病例，这些病例的胸段或复杂腹主动脉疾病的腔内移植物近端锚定区≥2。排除有症状的疾病、破裂以及急诊或紧急手术。患者按COPD严重程度分层。主要结局是住院死亡率。次要结局包括呼吸系统并发症和1年死亡率。采用多变量逻辑回归分析住院死亡率、呼吸系统并发症和1年死亡率。
在11336例接受TEVAR和CEVAR手术的患者中，66%无COPD，9%有COPD但未用药，20%有COPD且正在用药，6%有COPD且在家中吸氧。住院死亡率分别为2.3%、3.7%、3.2%和4.5%（P = 0.0004），且与死亡几率增加无关。呼吸系统并发症发生率分别为4.3%、4.5%、6.4%和7.3%（P < 0.0001），且与正在用药的COPD（比值比1.3）和在家中吸氧的COPD（比值比1.7）导致的几率增加相关。1年生存率分别为91%、87%、86%和80%，且与每个COPD组的风险增加相关（风险比1.4、风险比1.4、风险比1.9）。
接受TEVAR和CEVAR手术的COPD患者住院死亡率、呼吸系统并发症和1年死亡率均有所增加。COPD严重程度与呼吸系统并发症和1年死亡率增加独立相关，术前决策时应考虑这一点。
