O-008 - IDENTIFYING WOMEN AT HIGH RISK OF 90-DAY MORTALITY AFTER ELECTIVE OPEN ABDOMINAL AORTIC ANEURYSM REPAIR: THE CASE-CONTROL ROSA STUDY.

TOPIC:
Abdominal Aortic Aneurysms
AUTHORS:
Tedjawirja V. (Amsterdam UMC, University of Amsterdam ~ Amsterdam ~ Netherlands) , Bulder R. (Leiden University Medical Centre, Department of Vascular Surgery ~ Leiden ~ Netherlands) , Lindeman J. (Leiden University Medical Centre, Department of Vascular Surgery ~ Leiden ~ Netherlands) , Hamming J. (Leiden University Medical Centre, Department of Vascular Surgery ~ Leiden ~ Netherlands) , Balm R. (Amsterdam UMC, University of Amsterdam ~ Amsterdam ~ Netherlands) , Koelemay M. (Amsterdam UMC, University of Amsterdam ~ Amsterdam ~ Netherlands)
Introduction:
Women undergoing elective open surgical repair (OSR) of abdominal aortic aneurysm (AAA) have a high perioperative mortality risk. A sex-specific study was undertaken that aimed to identify risk factors for 90-day mortality to enable identification of women at high risk.
Methods:
In a national multicentre case-control study, women who died <90 days after elective OSR (cases) were compared with women who survived the 90-days (controls). Eligible patients were identified through the nation-wide mandatory quality registry of aortic aneurysm repairs (2013-2019) and controls were obtained from the same hospital as the cases. Using logistic regression analysis, preoperative and operative risk factors associated with mortality were identified in the whole sample and after matching for age. The mesenteric arteries were also assessed on preoperative computed tomography scans.
Results:
In total, we included 266 patients (30 cases, 236 controls) from 21 hospitals. Cases were older (median (IQR) age: 75 years (71-78.3) versus 71 years (66-77)) and more often had symptomatic peripheral arterial disease (PAD) (48.3% versus 21.6%). Intraoperative blood loss (1.6 litres (1.1-3.0) versus 1.2 (0.7-1.8)), acute myocardial infarction (AMI) (33.3% versus 3.4%), renal failure (56.7% versus 14.0%), and bowel ischaemia (BI) (56.7% versus 5.1%) were more prevalent among cases. Older age (OR 1.11, 95% CI 1.03-1.19) and PAD (OR 3.91, 95% CI 1.57-9.74) were associated with mortality. In an age-matched comparison, PAD was associated with mortality in univariable analysis. Multivariable analysis demonstrated that, irrespective of age, AMI (OR 9.34, 95% CI 1.66-52.4) and BI (OR 35.6, 95% CI 3.41-370) were associated with mortality. Only patients with a >70% stenosis of both the coeliac and superior mesenteric arteries had a higher risk of BI and mortality.
Conclusion:
Older age and symptomatic PAD increase the risk of mortality in women after elective OSR. Prevention of the complications AMI and BI is paramount to lower perioperative mortality in these women.
References:
This study was performed in collaboration with the ROSA Study Group Collaborators in alphabetical order: Akkersdijk GP, Boer GJ, Bouwman LH, Diks J, Elshof JW, Geelkerken RH, Ho GH, den Hoed PT, Keller BP, Klunder J, Koning OH, Kruse RR, Lardenoye JH, Lemson MS, Leeuwerke SJG, van der Linden FT, Pierie ME, van 't Sant HP, Schouten O, Schreuder S, The RM, van Silfhout L, van Tongeren RB, Vriens PW, Wiersema AM, Wiersma A, Zeebregts CJ.