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Operative mortality rates after elective infrarenal aortic reconstructions
T S Huber1, T R Harward, T C Flynn
1Department of Surgery, University of Florida College of Medicine, Gainesville 32610-0286, USA.
Insights
Multisystem organ failure (MSOF), not cardiac events, is the primary cause of death following elective aortic reconstructions. Increased procedure complexity and patient comorbidities elevate the risk of MSOF and operative mortality.
Area of Science:
- Vascular Surgery
- Surgical Outcomes
- Critical Care Medicine
Background:
- Cardiac complications were historically the leading cause of mortality after aortic reconstructions.
- Advances in perioperative care may have altered the primary causes of death.
Purpose of the Study:
- To test the hypothesis that cardiac complications are no longer the leading cause of death after elective aortic reconstructions.
- To identify the primary causes of perioperative mortality in contemporary aortic reconstruction.
Main Methods:
- Retrospective review of 722 elective infrarenal aortic reconstructions (1982-1994).
- Analysis of perioperative deaths to determine causes.
- Comparison with survivors to identify risk factors.
Main Results:
- Overall mortality rate was 6.1% (44 deaths).
- Multisystem organ failure (MSOF) caused 56.8% of deaths, followed by cardiac events (25%).
- Visceral organ dysfunction and pneumonia were common MSOF causes; age, comorbidities, and procedure complexity increased mortality.
Conclusions:
- MSOF, particularly from visceral organ dysfunction, is the leading cause of death after elective infrarenal aortic reconstruction.
- Operative mortality risk is associated with procedural complexity and patient comorbidities.
Purpose:
This study was designed to test the hypothesis that cardiac complications (myocardial infarction, congestive heart failure, fatal arrhythmias) are no longer the leading cause of death after elective aortic reconstructions.
Methods:
The medical records of all elective infrarenal aortic reconstructions performed between January 1982 and June 1994 were retrospectively reviewed. All perioperative deaths were analyzed to determine the cause of death and were compared with a subset of 266 survivors to identify any associated preoperative or intraoperative factors.
Results:
Seven hundred twenty-two aortic reconstructions were performed for aneurysmal or occlusive disease, and there were 44 deaths (overall mortality rate of 6.1%). The mortality rate after aortic reconstruction alone was 4.9% and increased with the addition of renal (8.9%, p = 0.16) or lower extremity vascular procedures (15.8%, p = 0.01). Multisystem organ failure (MSOF) was the cause of death in 56.8%, of the patients (3.5% overall mortality rate) followed by cardiac events in 25% (1.5% overall mortality rate). Visceral organ dysfunction was the most common cause of MSOF leading to death in 14 patients (56.0%), and postoperative pneumonia was responsible for the fatal MSOF in nine patients (36.0%). Patient age, history of myocardial infarction/congestive heart failure, ejection fraction less than 50%, duration of operative time, and performance of additional procedures were associated with increased operative mortality rates by multivariate analysis.
Conclusions:
MSOF, predominantly from visceral organ dysfunction, was the leading cause of death after elective infrarenal aortic reconstruction. The risk of MSOF and operative death increases with the complexity of the procedure and the number of comorbid conditions.