Association between Operating Time and Post-operative Outcomes in Complex Aortic Endografting: A Single Centre...

Area of Science:

• Vascular Surgery
• Endovascular Repair
• Surgical Outcomes

Background:

• Complex endovascular aortic repair (EVAR) encompasses fenestrated (FEVAR), branched (BEVAR), and arch branched (aBEVAR) procedures.
• Operating time (OT) is a critical metric in surgical procedures, potentially influencing patient outcomes.
• Understanding factors affecting OT is crucial for optimizing complex EVAR procedures.

Purpose of the Study:

• To assess the association between operating time (OT) and 30-day post-operative outcomes in complex EVAR.
• To identify factors contributing to variations in OT, including hospital volume and the learning curve.
• To evaluate the impact of prolonged OT on complication and mortality rates.

Main Methods:

• Retrospective observational cohort study of 530 patients undergoing complex EVAR (FEVAR, BEVAR, aBEVAR).
• Operating time defined as the interval from first arterial access to closure.
• Analysis included factors like hospital volume, learning curve, adjunctive procedures, and technique, alongside 30-day outcomes.

Main Results:

• Median OT varied by procedure type (FEVAR: 145 min, BEVAR: 181 min, aBEVAR: 159.5 min).
• Thirty-day mortality was significantly higher in the longest OT tertile (9.1%) compared to the shortest (0.0%) (p < .001).
• Multivariable analysis confirmed prolonged OT as an independent predictor of increased 30-day mortality (aOR 1.010 per minute).
• OT decreased over the study period, indicating a learning curve effect (p < .001).

Conclusions:

• Prolonged operating time is independently associated with increased 30-day mortality following complex EVAR.
• Outcomes improved over time with decreasing OT, suggesting a significant learning curve effect.
• Findings from this single-center study highlight the importance of optimizing OT in complex aortic repair, though caution is advised due to the retrospective design.