Impact of housing status on postoperative outcomes following endovascular and open abdominal aortic aneurysm repair

Unhoused individuals face a three-fold higher risk of cardiovascular disease-related morbidity and mortality compared with housed populations. However, limited data exist on outcomes following vascular surgery in this group. This study aimed to evaluate perioperative and postoperative outcomes following infrarenal aortic aneurysm repair, comparing housed and unhoused patients.

A retrospective cohort study was conducted using the Vascular Quality Initiative database from 2010 to 2020. Patients undergoing open or endovascular abdominal aortic aneurysm (AAA) repair were stratified by housing status at presentation. The primary outcome was survival, and secondary outcomes examined perioperative complications. Multivariable Cox regression and propensity score matching were used to balance groups. Statistical analyses included t-tests, χ² tests, and Kaplan-Meier survival analysis with log-rank testing.

Over a 10-year period, 99,733 patients were identified, of whom 99,606 (99.9%) were housed and 127 (0.1%) were unhoused. Unhoused patients were significantly more likely to undergo open repair compared with housed patients (26.8% vs 18.0%; P = .015). Housed patients were older, with a mean age of 72.80 ± 0.03 years compared with 65.20 ± 0.80 years for unhoused patients (P < .001). Unhoused patients were also more likely to present with symptomatic or ruptured aneurysms (44.1% vs 17.7%; P < .001). The mean postoperative survival was significantly shorter for unhoused patients (1156.6 ± 136.52 days) compared with housed patients (1580.7 ± 5.46 days; P = .003). Adjusting for procedure type, age, preoperative characteristics, and urgency, the survival disadvantage of unhoused patients was no longer significant. Among unhoused patients aged ≥65 years, 1-year survival was approximately 45% for open AAA repair compared with 85% for endovascular aneurysm repair (P = .005).

Unhoused patients experience poorer survival compared with housed patients following infrarenal AAA repair. Despite being younger, their worse outcomes may be attributed to more urgent presentations. Notably, survival was poorest among unhoused patients aged ≥65 years undergoing open repair, highlighting a particularly vulnerable population.