V. Pandit1, M. N. Khan1, M. Zeeshan1, M. Hamidi1, F. S. Jehan1 1University Of Arizona,Tucson, AZ, USA
Introduction:
The rates of complications following endovascular repair (EVAR) of abdominal aortic aneurysm (AAA) are well known; however, the data regarding timing are opaque. Accordingly, we sought to assess the median time-to-event for principal postoperative complications within 30 days following surgery.
Methods:
Patients undergoing EVAR of AAA were identified within the American College of Surgeons National Surgical Quality Improvement Program database (2013–2015). Primary endpoint was time-to-complication. Secondary endpoints included length-of-stay (LOS), re-admission and 30-day mortality. Multivariable regression models assessed the predictors for pre-/post-discharge complications and the effect of time-to-complication on secondary outcomes.
Results:
Overall, 12,279 patients underwent EVAR of AAA. The overall complication rate was 27%. 23.1 % patients had major complications while 3.9% patients suffered from minor complications. The median LOS was 2[1-3] days and patients were discharged on post-op day 1[1-3]. The majority of major complications (88.1 %), including bleeding / transfusion, renal, septic, deep venous thrombosis or pulmonary embolism, pulmonary, cardiac and neurologic, occurred prior to discharge. Conversely, the relatively minor complications, including wound and urinary tract infections, occurred predominantly post-discharge (70.7 %). The median time to major complications was 3.7 versus 14 days for minor complications. In multivariable analyses, age (p < 0.01), American Society of Anesthesiologists score ≥ 3 (p < 0.01), while male gender (p < 0.01), hypertension (p < 0.01) and diabetes (p < 0.01) were predictors of post-discharge complications. For a given complication, time-to-complication did not affect the odds for mortality (p = 0.45) or re-admission (p = 0.79).
Conclusion:
Approximately one in four patients suffers a complication following endovascular repair of abdominal aortic aneurysm; major complications tend to occur early with the majority occurring pre-discharge. Knowledge regarding the timing and risk factors for complications may facilitate improved patient–physician communication, both at admission and at discharge.
