Functional status as a predictor of outcomes in open and endovascular abdominal aortic aneurysm repair

• Published in: Journal of vascular surgery 2017-01, Vol.65 (1), p.40-45
• Main Authors: Endicott, Kendal M., MD, Emerson, Dominic, MD, Amdur, Richard, PhD, Macsata, Robyn, MD
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - surgery; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - mortality; Chi-Square Distribution; Databases, Factual; Decision Support Techniques; Endovascular Procedures - adverse effects; Endovascular Procedures - mortality; Female; Geriatric Assessment; Health Status Indicators; Hospital Mortality; Humans; Length of Stay; Logistic Models; Lung Diseases - etiology; Male; Multivariate Analysis; Odds Ratio; Predictive Value of Tests; Retrospective Studies; Risk Factors; Surgery; Time Factors; Treatment Outcome; United States; United States Department of Veterans Affairs
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2016.05.079

Abstract Background Functional status is a simple and rapidly assessable metric that may be used as a predictor for surgical outcomes. This study examined the association of functional status with short-term mortality after abdominal aortic aneurysm (AAA) repair in octogenarians to characterize the utility of functional status as a means of preoperative risk assessment. Methods All patients who underwent endovascular and open AAA repair from 2002 to 2010 within the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database were identified. Functional status, defined as an ordinal scale from 1 to 3 (1, independent; 2, partially dependent; 3, totally dependent), was examined using multivariate regression models with 30-day mortality as the primary outcome. For the purpose of analysis, this 3-point scale was converted into a binomial scale of function, with “normal” including 1 (completely independent) and “abnormal” including 2 or 3 (partially to totally dependent). Results We identified 9030 patients who underwent AAA repair (46.6% open and 53.4% endovascular). Mortality at 30 days was 2.8% for the entire cohort (4.2% open, 1.7% endovascular; P  < .001). There were 1340 patients aged ≥80 years, of which 67.3% underwent endovascular AAA repair. Among all age groups, functional status was a significant predictor of 30-day mortality (