Defining high-risk patients for endovascular aneurysm repair

• Published in: Journal of vascular surgery 2009-12, Vol.50 (6), p.1271-1279.e1
• Main Authors: Egorova, Natalia, PhD, MPH, Giacovelli, Jeannine K., MD, MPH, Gelijns, Annetine, PhD, Greco, Giampaolo, PhD, MPH, Moskowitz, Alan, MD, McKinsey, James, MD, Kent, K. Craig, MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - surgery; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - mortality; Female; Health Status Indicators; Humans; Logistic Models; Male; Medicare; Odds Ratio; Patient Selection; Predictive Value of Tests; Reproducibility of Results; Risk Assessment; Risk Factors; ROC Curve; Surgery; Time Factors; Treatment Outcome; United States - epidemiology
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2009.06.061

Background Endovascular aneurysm repair (EVAR) is commonly used as a minimally invasive technique for repairing infrarenal aortic aneurysms. There have been recent concerns that a subset of high-risk patients experience unfavorable outcomes with this intervention. To determine whether such a high-risk cohort exists and to identify the characteristics of these patients, we analyzed the outcomes of Medicare patients treated with EVAR from 2000-2006. Methods We identified 66,943 patients who underwent EVAR from Inpatient Medicare database. The overall 30-day mortality was 1.6%. A risk model for perioperative mortality was developed by randomly selecting 44,630 patients; the other one third of the dataset was used to validate the model. The model was deemed reliable (Hosmer-Lemeshow statistics were P = .25 for the development, P = .24 for the validation model) and accurate (c = 0.735 and c = 0.731 for the development and the validation model, respectively). Results In our scoring system, where scores ranged between 1 and 7, the following were identified as significant baseline factors that predict mortality: renal failure with dialysis (score = 7); renal failure without dialysis (score = 3); clinically significant lower extremity ischemia (score = 5); patient age ≥85 years (score = 3), 75-84 years (score = 2), 70-74 years (score = 1); heart failure (score = 3); chronic liver disease (score = 3); female gender (score = 2); neurological disorders (score = 2); chronic pulmonary disease (score = 2); surgeon experience in EVAR