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The Relationship Between Peri-Operative Systemic Inflammation and Survival in Patients With Abdominal Aortic Aneurysm
Nicholas A Bradley1, Amy Walter2, Alasdair Wilson3
1Clinical Research Fellow, University of Glasgow, Glasgow, Scotland, UK.
Annals of Vascular Surgery
|October 12, 2024
Summary
Systemic inflammation markers, both before and after surgery, are linked to poorer survival rates in patients undergoing abdominal aortic aneurysm (AAA) repair. Elevated C-reactive protein (CRP) post-surgery is a key indicator of increased mortality risk.
Area of Science:
- Vascular Surgery
- Inflammation Biology
- Clinical Outcomes Research
Background:
- Systemic inflammation markers are linked to worse outcomes after abdominal aortic aneurysm (AAA) repair.
- The prognostic significance of postoperative inflammation in AAA patients is not well-established.
- This study investigates the association between perioperative inflammation and mortality in AAA repair patients.
Purpose of the Study:
- To assess the impact of preoperative and postoperative inflammatory markers on mortality following endovascular aneurysm repair (EVAR) and open surgical repair (OSR) for infrarenal AAA.
- To identify specific inflammatory markers that predict short-term and long-term survival in AAA patients.
Main Methods:
- Retrospective analysis of consecutive patients undergoing emergency or elective AAA repair across three centers.
- Assessment of preoperative systemic inflammation using the modified Glasgow Prognostic Score.
- Evaluation of day 3 postoperative C-reactive protein (CRP) levels (>300 mg/L vs. ≤300 mg/L) as a key covariate.
- Primary outcomes: 30-day mortality for emergency cases and 12-month mortality for elective cases.
Main Results:
- In the emergency cohort, preoperative modified Glasgow Prognostic Score 2 independently predicted 30-day mortality (OR: 2.11).
- In the elective cohort, age ≥75 (OR: 5.15) and day 3 postoperative CRP >300 mg/L (OR: 15.68) independently predicted 12-month mortality.
- Higher day 3 CRP levels were significantly associated with reduced survival in the elective cohort (112 months vs. 67 months).
Conclusions:
- Both preoperative and postoperative systemic inflammation markers are independently associated with inferior survival after AAA repair.
- Elevated day 3 postoperative CRP is a significant predictor of mortality in both emergency and elective AAA repair.
- Further research into the perioperative inflammatory response in AAA patients is warranted to identify potential intervention targets.
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