Short-Term Complications and Mortality Following Open Abdominal Aortic Aneurysm Repair by a Single High-Volume...

Although endovascular repair is now considered the first-line surgical treatment for abdominal aortic aneurysms (AAAs), some surgeons maintain a high volume of open aortic repairs (OARs) with very good outcomes. This study examines postoperative 30-d and 12-mo mortality and in-hospital complications from a single surgeon who performed 316 elective OARs for unruptured AAAs over a 10-y period.

A retrospective cohort study was performed for all patients who underwent elective OAR for unruptured AAAs between April 1st, 2007, and March 31st, 2017, at a single community center in Quebec, Canada. The primary outcome was the incidence of all-cause 30-d and 12-mo mortality in patients undergoing OAR. Binomial logistic and linear regressions were performed to examine whether operative time correlated with postoperative outcomes.

There were 316 patients included: most of whom were male (74.4%), with a mean age of 70 y, and a mean AAA diameter of 59.8 mm. Most patients had a low-to-intermediate predicted risk of postoperative major cardiovascular complications, myocardial infarction, or in-hospital mortality. At the time of OAR, 95.6% of patients were asymptomatic, 70.9% had a tube graft repair, and very few required suprarenal aortic clamping (1.6%). The mean operative time was 101 min, and the median length of hospital stay was six days. One patient died in hospital or within 30 d of surgery (0.3%), and 7 patients had died 12 mo after surgery (2.2%). All-cause mortality was 27.5% (87 patients) over a median follow-up of 5.5 y. Twenty-five percent of patients suffered any in-hospital complication postoperatively, and 18 (5.7%) patients suffered a major cardiac complication. The operative time was significantly associated with increased risk of any in-hospital complication (OR 1.02, 95% CI [1.01, 1.03], P = 0.001), reintervention (OR 1.04, 95% CI [1.02, 1.06], P = 0.001), and length of stay in hospital (β = 0.063, 95% CI [0.01, 0.11], P = 0.044) or intensive care unit (β = 0.043, 95% CI [0.01, 0.08], P = 0.021). There was no association between operative time and mortality at any time point.

Favorable postoperative outcomes can be achieved with OAR as the first-line surgical management of unruptured asymptomatic AAAs when performed by an experienced high-volume surgeon in appropriately selected patients with favorable perioperative risk factors.