Factors affecting patients' functional status and their impact on outcomes of ruptured abdominal aortic aneurysms

Despite advances in surgical techniques, ruptured abdominal aortic aneurysm (rAAA) remains associated with extremely high mortality. Several preoperative risk factors have been shown to predict poor prognosis after rAAA repair. Notably, a preoperative dependent functional status has previously been shown to be associated with poor outcomes after several vascular surgery procedures. The purpose of this study was to examine the effect of preoperative functional status on postoperative outcomes for patients undergoing repair of rAAA.

Patients with rAAA were identified in the American College of Surgeons National Surgical Quality Improvement Program database for the year 2013. The patients' demographics, procedural data, and postoperative outcomes were analyzed. Patients were then divided into two groups: dependent functional status and independent functional status. Preoperative variables and outcomes were compared between these two groups. A multivariate logistic regression analysis was then conducted to assess independent risk factors that predispose to dependent functional status.

A total of 1239 patients underwent repair of rAAAs. Of these, 34 patients did not have a recorded functional status. The total number of patients analyzed was therefore 1205 (male, 78%; female; 22%; group I, dependent functional status, n = 62 [5%]; group II, independent functional status, n = 1143 [95%]). Bivariate analysis identified the following variables as having a significant association with dependent functional status: age >80 years (odds ratio [OR], 8.70; confidence interval [CI] 1.18-64.43; P = .002), female sex (OR, 2.89; CI, 1.71-4.87; P < .001), dyspnea (OR, 3.77; CI, 2.0-7.13; P < .001), dialysis (OR, 7.55; CI, 3.21-17.73; P < .001), insulin-dependent diabetes mellitus (vs nondiabetic: OR, 3.76; CI, 1.39-10.21; P = .033), current smoker (OR, 0.41; CI, 0.22-0.77; P = .005), and hypertension (OR, 2.86; CI, 1.4-5.87; P = .004). Preoperative functional status had no effect on the following postoperative outcomes: surgical site infection, cardiac arrest, unplanned intubation, readmission, return to the operating room, and death. Dependent functional status was associated with increased length of hospital stay (group I, median of 10 days; group II, median of 7 days).

Dependent functional status is considered to be strongly associated with poor outcomes after surgical operations. Our study shows that functional status has little or no bearing on the outcomes of operations for rAAA and that preoperative dialysis, female sex, advanced age, and dyspnea are strong predictors of dependent functional status. Dependent functional status should not be used to exclude patients with rAAA from being offered surgical treatment.