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Temporal Trends in 30-Day Mortality and Major Complications after Endovascular Repair of Abdominal Aortic Aneurysm: A 10-Year Review of Outcomes.
Kanhua Yin1, Satinderjit S. Locham, MD2, Besma Nejim, MD, MPH2, Hanaa Dakour Aridi, MD2, Mahmoud Malas, MD, MHS, RPVI, FACS2.
1Shanghai Medical College, Shanghai, China, 2John Hopkins Hospital, Baltimore, MD, USA.

Objective: Significant research efforts have been made to improve the safety and efficacy of endovascular aneurysm repair (EVAR) in treating abdominal aortic aneurysm (AAA). However, temporal trends in the 30-day mortality and major postoperative complications of EVAR in the treatment of AAA remain unknown. This study aims to examine the trends of outcomes using a national database.
Methods: Patients who underwent EVAR for intact AAA between 2006 to 2015 were identified in the ACS-NSQIP. They were classified into two groups according to the years they received surgery: group A (2006 to 2010) and group B (2011 to 2015). The 30-day mortality and postoperative major complications (renal, cardio-pulmonary and wound infection) were compared. Multivariable logistic regression was applied to evaluate the risk factors affecting postoperative major complications.
Results: A total of 29,378 intact EVARs were identified, out of which, 11,305(38.5%) were in Group A and 18,073(61.5%) in Group B. Patients in Group B were more likely to be females (19.4% vs. 17.4%), blacks (4.8% vs. 4.0%), and have high prevalence of diabetes (16.1% vs. 15.2%) and bleeding disorders (11.5% vs. 10.7%)(All p<0.05). Group B also had significant lower operation time (mean (S.D.): 141.26(+72.72) vs. 155.56(+72.32)) and length of stay (mean(S.D.): 2.80(+4.30) vs. 3.25(+5.34)) compared to Group A (Both p<0.05). There was no significant difference in 30-day mortality between the two groups (1.2% vs. 1.2%, p=0.85). Additionally, group B had significant lowered rate of major complications (5.3% vs. 6.5%), renal (2.4% vs. 3.0%) cardio-pulmonary (1.7% vs. 2.2%) and wound infections (1.9% vs. 2.5%)(All p<0.05). The overall postoperative major complications rate also decreased from 7.5% in 2006 to 4.2% in 2015 (figure 1). In a multivariate analysis, group B had 17% reduction of major complications compared to group A [OR (95% CI): 0.83(0.74-0.92), P<0.001]. Pre-operative transfusion had two-folds increase in the risk of postoperative major complications [OR (95% CI): 2.35(1.40-3.95), P<0.001].
Conclusion: Although the 30-day mortality remains similar, postoperative complications in EVAR have decreased significantly during the recent decade. We caution against pre-operative transfusion as it has the highest impact on the risk of postoperative complications of EVAR.


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