The impact of exposure technique on perioperative complications in patients undergoing elective open abdominal aortic aneurysm repair

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• 作者：Pedro G.R. Teixeira ; MD^a ; Karen Woo ; MD ; MS^b ; Ahmed M. Abou-Zamzam ; MD^c ; Sara L. Zettervall ; MD^d ; Marc L. Schermerhorn ; MD^d ; Fred A. Weaver ; MD ; MMM^e ; ^{fweaver@med.usc.edu" class="auth_mail" title="E-mail the corresponding author}
• 刊名：Journal of Vascular Surgery
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：63
• 期：5
• 页码：1141-1146
• 全文大小：145 K

文摘

The objective of this study was to evaluate the impact of exposure technique on perioperative complications in patients undergoing elective open abdominal aortic aneurysm (AAA) repair.

Methods

Using the Society for Vascular Surgery Vascular Quality Initiative database, the study identified patients subjected to open AAA repair from January 2003 to July 2014 and divided them into two aortic exposure groups, retroperitoneal (RP) and transperitoneal (TP). Multivariable analysis was performed to compare the incidence of cardiac events (myocardial infarction, dysrhythmia, heart failure), prolonged intubation, renal dysfunction, and mortality, adjusting for between-group differences identified on univariate analysis.

Results

Open AAA repair was performed in 3530 patients, using RP in 26% and TP in 74%. The RP group had a higher rate of suprarenal aortic clamp (60.9% vs 30.2%; P < .001), higher proportion of high-risk patients as stratified by the Vascular Study Group of New England Cardiac Risk Index (25.6% vs 22.2%; P = .038), and lower rate of iliac aneurysms (18.0% vs 31.2%; P < .001). After multivariable analysis, RP was associated with a lower incidence of cardiac events (12.2% vs 16.0%; adjusted odds ratio, 0.60; 95% confidence interval, 0.41-0.88; P = .009) and renal dysfunction (13.3% vs 16.5%; adjusted odds ratio, 0.65; 95% confidence interval, 0.46-0.97; P = .011). No difference in respiratory complications or mortality was identified.

Conclusions

Despite increased utilization of suprarenal aortic clamp during elective open AAA repair, the RP technique was associated with a lower risk-adjusted incidence of cardiac and renal complications compared with the TP technique.