Elective ascending aortic aneurysm repair outcomes in a nationwide US cohort.

Publisher: BMJ Pub. Group Country of Publication: England NLM ID: 9602087 Publication Model: Electronic Cited Medium: Internet ISSN: 1468-201X (Electronic) Linking ISSN: 13556037 NLM ISO Abbreviation: Heart Subsets: MEDLINE

Original Publication: London : BMJ Pub. Group, c1996-

Aortic Aneurysm, Abdominal*/surgery ; Aneurysm, Ascending Aorta* ; Myocardial Infarction* ; Stroke*/epidemiology ; Stroke*/etiology ; Endovascular Procedures*; Adult ; Humans ; Female ; Male ; Hospital Mortality ; Vascular Surgical Procedures/adverse effects ; Risk Factors ; Retrospective Studies ; Treatment Outcome ; Postoperative Complications ; Elective Surgical Procedures/adverse effects ; Risk Assessment

Objective: To quantify contemporary outcomes following elective ascending aortic aneurysm repair, to determine risk factors for adverse events and to evaluate difference by institutional surgical volume.
Methods: We included all elective hospitalisations of adult patients with an ascending aortic aneurysm who underwent aneurysm repair in the Nationwide Readmissions Database between 2016 and 2019. The primary outcome was a composite of in-hospital mortality, stroke (ischaemic and non-ischaemic) and myocardial infarction (MI). We identified independent predictor of adverse events and investigated outcomes by institutional volume.
Results: Among 12 043 patients (mean 62.8 years of age, 28.0% female), MI, stroke or in-hospital death occurred in 598 (4.9%) patients during the index admission (acute stroke: 2.7%, MI: 0.7%, in-hospital death: 2.0%). The strongest predictors of in-hospital death, stroke or MI were chronic weight loss, pulmonary circulation disorder and concomitant descending aortic surgery. Higher procedural volume was associated with a lower incidence of in-hospital death, stroke or MI (OR comparing the highest with the lowest tertile 0.71, 95% CI 0.57 to 0.87; p=0.001) and in-hospital death (OR 0.51, 95% CI 0.37 to 0.72; p<0.001), but no difference in 30-day readmissions.
Conclusions: The overall rate of in-hospital death, stroke and MI is nearly 5% in patients undergoing elective ascending aortic aneurysm repair. Among several predictors, chronic weight loss is associated with the largest increase in the risk of poor outcomes. Higher hospital volume is associated with a lower in-hospital mortality, highlighting the importance to refer patients to high-volume centres while discussing the risks and benefits of proceeding with repair.
Competing Interests: Competing interests: EAS reports institutional research support from NIH/NHLBI (K23HL150290), Food & Drug Administration, BD, Boston Scientific, Cook, CSI, Laminate Medical, Medtronic and Philips. He is a consultant/speaker for Abbott, Bayer, BD, Boston Scientific, Cook, CSI, Medtronic, Philips and VentrureMed. BJC reports institutional research support from Bristol-Myers Squibb and Inari. He is a consultant for Reliant Medical and Janssen.
(© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

K23 HL150290 United States HL NHLBI NIH HHS

Keywords: aortic aneurysm; outcome assessment, health care

Date Created: 20230317 Date Completed: 20230628 Latest Revision: 20240725

20240726

10.1136/heartjnl-2022-322033

36928243