Identifying Women at High Risk of 90 Day Death after Elective Open Abdominal Aortic Aneurysm Repair: A Multicentre Case Control Study

Victoria N Tedjawirja; Ruth M A Bulder; Jan H N Lindeman; Jaap F Hamming; Susan van Dieren; Ron Balm; Mark J W Koelemay; Study Group Collaborators

doi:10.1016/j.ejvsvf.2022.10.005

Identifying Women at High Risk of 90 Day Death after Elective Open Abdominal Aortic Aneurysm Repair: A Multicentre Case Control Study

EJVES Vasc Forum. 2022 Nov 9:57:17-27. doi: 10.1016/j.ejvsvf.2022.10.005. eCollection 2022.

Authors

Victoria N Tedjawirja¹, Ruth M A Bulder², Jan H N Lindeman², Jaap F Hamming², Susan van Dieren¹, Ron Balm¹, Mark J W Koelemay¹; Study Group Collaborators

Collaborators

Study Group Collaborators:
G P Akkersdijk³, G J Boer³, L H Bouwman⁴, J Diks⁵, J W Elshof⁶, R H Geelkerken^{7

8}, G H Ho⁹, P T den Hoed¹⁰, B P Keller¹¹, J W Klunder¹², O H Koning¹³, R R Kruse¹⁴, J H Lardenoye¹⁵, M S Lemson¹⁶, S J G Leeuwerke⁷, F T van der Linden¹⁷, M E Pierie¹⁸, H P van 't Sant¹⁹, O Schouten²⁰, S M Schreuder²¹, R M The¹², L van Silfhout¹⁶, R B van Tongeren²², P W Vriens²³, A M Wiersema²⁴, A Wiersma¹¹, C J Zeebregts²⁵

Affiliations

¹ Amsterdam UMC location University of Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
² Leiden University Medical Centre, Department of Vascular Surgery, Leiden, the Netherlands.
³ Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands.
⁴ Department of Surgery, Zuyderland, Sittard-Geleen, Heerlen Brunssum, the Netherlands.
⁵ Department of Surgery, Bravis Hospital, Bergen op Zoom Roosendaal, the Netherlands.
⁶ Department of Surgery, VieCuri Hospital, Venlo Venray, the Netherlands.
⁷ Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, the Netherlands.
⁸ Multi-Modality Medical Imaging Group, Techmed Center, University of Twente, Enschede, the Netherlands.
⁹ Department of Surgery, Amphia Hospital, Breda, the Netherlands.
¹⁰ Department of Surgery, Ikazia Hospital, Rotterdam, the Netherlands.
¹¹ Department of Surgery, Martini Hospital, Groningen, the Netherlands.
¹² Department of Surgery, St. Jansdal Hospital, Harderwijk, the Netherlands.
¹³ Department of Surgery, Jeroen Bosch Ziekenhuis, 's Hertogenbosch, the Netherlands.
¹⁴ Department of Surgery, Ziekenhuis Groep Twente, Hengelo Almelo, the Netherlands.
¹⁵ Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands.
¹⁶ Department of Surgery, Slingeland Hospital, Doetinchem, the Netherlands.
¹⁷ Department of Surgery, St. Anna Hospital, Geldrop Eindhoven, the Netherlands.
¹⁸ Department of Surgery, Isala Hospital, Zwolle, the Netherlands.
¹⁹ Department of Surgery, OLVG, Amsterdam, the Netherlands.
²⁰ Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands.
²¹ Department of Radiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
²² Department of Surgery, Deventer Hospital, Deventer, the Netherlands.
²³ Department of Surgery, Elizabeth TweeSteden Hospital, Tilburg, the Netherlands.
²⁴ Department of Surgery, Dijklander Hospital, Purmerend, the Netherlands.
²⁵ Department of Surgery (Division of Vascular surgery), University Medical Center of Groningen, University of Groningen, Groningen, the Netherlands.

Abstract

Objective: The aim of this study was to identify risk factors for 90 day death after elective open surgical repair (OSR) of abdominal aortic aneurysms (AAAs) in women.

Methods: This was a multicentre case control study. The nationwide Dutch Surgical Aneurysm Audit registry (2013-2019) was solely used to identify women who underwent elective OSR as eligible patients. Data for this study were subsequently collected from the patients' medical files. Women with AAA were included and those who died (cases) were compared with those who survived (controls) 90 days after surgery. Inflammatory, mycotic, or symptomatic or ruptured AAA were excluded. The association between pre- and peri-operative risk factors and death was assessed by logistic regression analysis in the whole sample and after matching cases to controls of the same age at the time of repair. Mesenteric artery patency was also assessed on pre-operative computed tomography and used in the analysis.

Results: In total, 266 patients (30 cases and 236 controls) from 21 hospitals were included. Cases were older (median [interquartile range; IQR] 75 years [71, 78.3] vs. 71 years [66, 77]; p = .002) and more often had symptomatic peripheral arterial disease (PAD) (14/29 [48%] vs. 49/227 [22%]; p = .002). Intra-operative blood loss (median [IQR] 1.6 L [1.1, 3.0] vs. 1.2 L [0.7, 1.8]), acute myocardial infarction (AMI) (10/30 [33%] vs. 8/236 [3%]), renal failure (17/30 [57%] vs. 33/236 [14%]), and bowel ischaemia (BI) (17/29 [59%] vs. 12/236 [5%]) were more prevalent among cases. Older age (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.03-1.19) and PAD (OR 3.91, 95% CI 1.57-9.74) were associated with death. Multivariable analysis demonstrated that, after adjustment for age, AMI (OR 9.34, 95% CI 1.66-52.4) and BI (OR 35.6, 95% CI 3.41-370) were associated with death. Superior mesenteric artery stenosis of >70% had a clinically relevant association with BI (OR 5.23, 95% CI 1.43-19.13; p = .012).

Conclusion: Age, symptomatic PAD, AMI, and BI were risk factors for death after elective OSR in women. The association between a >70% SMA stenosis and BI may call for action in selected cases.

Keywords: Abdominal aortic aneurysm; Mortality; Risk factors; Surgery; Women.