The Relationship Between Peri-Operative Systemic Inflammation and Survival in Patients With Abdominal Aortic Aneurysm

An association between preoperative markers of systemic inflammation and inferior mortality following abdominal aortic aneurysm (AAA) repair has been observed. The prognostic value of the postoperative inflammatory response remains unreported in patients with AAA. This study aimed to describe the association between the perioperative inflammatory response and mortality in patients undergoing endovascular aneurysm repair and open surgical repair (OSR) for infrarenal AAA.

Consecutive patients undergoing either emergency (endovascular aneurysm repair or OSR) or elective (OSR) intervention for infrarenal AAA were retrospectively recruited from 3 centers. Preoperative systemic inflammation was assessed using the modified Glasgow Prognostic Score. Day 3 postoperative C-reactive protein (CRP) (≤300 mg/L, >300 mg/L) was chosen as the covariate of interest. The primary outcome was 30-day mortality in the emergency cohort and 12-month mortality in the elective cohort.

There were 167 emergency cases (120 (72%) OSR) and 207 elective (207 (100%) OSR) cases, with a median (interquartile range) follow-up of 85 (52) months in the emergency cohort and 63 (57) months in the elective cohort. There were 56% versus 44% of patients in the emergency cohort day 3 CRP ≤300 mg/l versus >300 mg/L compared with 82% versus 18% of patients in the elective cohort (P < 0.001). On univariate binary logistic regression analyses in the emergency cohort, open repair (P < 0.05), preoperative modified Glasgow Prognostic Score 2 (P < 0.05), postoperative mesenteric ischemia (P < 0.01), and day 3 postoperative CRP >300 mg/L (P < 0.05) were associated with increased odds of 30-day mortality. On multivariate binary logistic regression analyses, only preoperative modified Glasgow Prognostic Score 2 (odds ratio [OR]: 2.11, 95% confidence interval [CI]: 1.12-3.98, P < 0.05) retained independent association with 30-day mortality. In the elective cohort, mean (95% CI) survival in the day 3 CRP ≤300 mg/l versus >300 mg/L was 112.0 (101.8-122.2) months versus 67.2 (54.1-80.2) months (P < 0.001). On univariate binary logistic regression analyses in the elective cohort, age ≥75 (P < 0.05), ischemic heart disease (P < 0.05), and day 3 postoperative CRP >300 mg/L (P < 0.001) were associated with increased odds of 12-month mortality. On multivariate binary logistic regression analyses, both age ≥75 (OR: 5.15, 95% CI: 1.25-21.30, P < 0.05) and day 3 postoperative CRP >300 mg/L (OR: 15.68, 95% CI: 3.61-68.15, P < 0.001) retained independent association with 12-month mortality.

Preoperative and postoperative markers of systemic inflammation were independently associated with inferior survival following emergency and elective repair of AAA, respectively. Further investigation of the perioperative systemic inflammatory response is warranted in this patient group, with a particular focus on identifying targets for intervention.