Dementia Is Associated With Adverse Outcomes After Nonruptured Abdominal Aortic Aneurysm Repair

To compare outcomes after nonruptured abdominal aortic aneurysm (AAA) repair among Medicare beneficiaries with and without Alzheimer disease and related dementias (ADRD).

AAA repair carries substantial risks; outcomes data in patients with ADRD are extremely limited.

We conducted a retrospective cohort study using Medicare fee-for-service claims (2016-2020) of beneficiaries ≥66 years who underwent nonruptured AAA repair. ADRD was ascertained using a validated 12-month lookback algorithm. Outcomes were 30-, 90-day, and 1-year mortality, readmissions, major inpatient complications, and discharge destination. Associations were estimated with propensity score-weighted models adjusted for age, sex, race, Elixhauser comorbidity index, claims-based frailty, and repair type (endovascular vs open).

Of 42,733 repairs, 1817 (4.3%) involved patients with ADRD, who were older (median 80.8 vs 75.8 years), more often female (30.7% vs 25.0%), less often non-Hispanic White (84.2% vs 90.1%), and more likely to receive endovascular repair (89.1% vs 83.8%). Unadjusted outcomes were worse across mortality, readmissions, and major complications. After adjustment, ADRD was associated with higher mortality (30-day adjusted odds ratio [aOR] 1.50, 95% confidence interval [CI] 1.15-1.95; 1-year aOR 1.83, 95% CI 1.59-2.11), greater readmissions (30-day aOR 1.26, 95% CI 1.06-1.49; 90-day aOR 1.25, 95% CI 1.07-1.45), and increased discharge to higher-level care (aOR 2.46, 95% CI 2.12-2.85).

In this national cohort, ADRD was associated with increased mortality, readmissions, and discharge to higher-level care after AAA repair despite more frequent use of endovascular repair.