Risk Factors for Mortality after Thoracic Endovascular Aortic Repair Open Access
Hu, Frances Yifan (2017)
Abstract
Objective:
Over the past decade, thoracic endovascular aortic repair (TEVAR) has increased as a treatment option for a variety of aortic pathologies. Despite this rise in the use of thoracic stent grafts, real-world outcomes from a robust, adjudicated, contemporary dataset have yet to be reported. Previous studies have shown peri-procedural mortality rates between 1.5%-9.5% and procedure-related stroke rates of 2.3%-8.2%. With advances in device engineering and increased physician experience, we hypothesized that the rates of these complications would be reduced in a more recent sample set. The purpose of this study was to determine current rate of mortality after TEVAR, identify risk factors that contribute to thirty-day mortality, and develop a simple scoring system that allows for risk stratification of patients undergoing TEVAR.
Methods:We examined the 30-day mortality rate following TEVAR using the 2013-2014 American College of Surgeons National Surgical Quality Improvement Program database. Patients undergoing TEVAR for all aortic pathology were identified using procedure codes. Bivariate analyses were performed to evaluate the association of pre-, intra- and post-operative variables with 30-day mortality, followed by multivariable logistic analysis using pre-operative variables only, with P<.10 as criteria for model entry. The predictive logistic model was internally validated by cross validation. Variables included in the multivariable model were used to develop a risk score.
Results:Eight hundred twenty-six patients were included. The thirty-day mortality rate was 7.63% (n=63). In regression analysis, mortality was independently associated with age >=80 years (odds ratio [OR] 2.32, 95% confidence interval [CI] 1.25-4.31), emergency case (OR 2.61, 95% CI 1.39-4.90), ASA classification >3 (OR 2.89, 95% CI 1.34-6.24), transfusion >4 units in the 72 hours prior to surgery (OR 2.86, 95% CI 1.30-6.28), pre-operative creatinine >=1.8 mg/dL (OR 2.07, 95% CI 1.05-4.08), and pre-operative white blood cell count >=12 x 109/L (OR 2.65, 95% CI 1.41-4.96). Incorporating these factors, a six-point risk score was generated and demonstrated high predictability for overall thirty-day mortality.
Conclusions:Recent data from a national, retrospective dataset demonstrate that high perioperative mortality and stroke rates have persisted over the last decade. The risk score derived from this dataset is simple and convenient and serves as a prognostic tool in the pre-operative risk stratification of patients being evaluated for thoracic endovascular aortic repair.
Table of Contents
Table of Contents Abstract Title Page…………...………………………iii Abstract……….......................………………..….iv Title Page…..……………………………………....…….v Acknowledgements……………….....………….….vi List of Tables…………………………………………….vii List of Figures……………………………….………...viii I. Introduction………..…………………………….…...1 II. Background………..………………………………...2 III. Methods………………………………………….....16 IV. Results……………..…………………………….....22 V. Discussion……………………………....…….…...26 VI. References………………………………...…......34
VII. Tables/Figures…..…………………….……....44
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