Functional Status Predicts Major Complications and Death After Endovascular Repair of Abdominal Aortic Aneurysms

Endovascular aortic repair (EVAR) is a lower-risk option for treating abdominal aortic aneurysms (AAA), with particular utility in patients with poor functional status who may be unfit for open surgical repair. However, the contribution of preoperative functional status to outcomes after EVAR remains poorly defined. We hypothesized that impaired functional status is associated with worse outcomes after EVAR. Patients undergoing nonemergency EVAR for AAA between 2010 and 2014 were identified in the National Surgical Quality Improvement Program (NSQIP) database. The primary outcomes were 30-day mortality and major operative (deep wound infection, dehiscence, bleeding events, or device complications) and systemic (cardiac events, respiratory complications, stroke, or acute renal failure) complications. Secondary outcomes were inpatient length of stay, readmission, and reoperation. Using NSQIP defined preoperative functional status, patients were stratified as independent or partially or dependent and compared by univariate analyses. The effect of functional status on mortality and major complications was assessed by multivariable logistic regression. Of 13,432 NSQIP patients undergoing nonemergency EVAR during 2010 to 2014, 13,043 were Independent (97%) and 389 were dependent. Dependent patients were older and more often minorities; had higher rates of COPD, heart failure, and renal failure; and were more likely to have an American Society of Anesthesiologists (ASA) score of 4 or 5 (Table I). Preoperative dependent status was associated with higher rates of operative complications (34% vs 11%; P < .0001), systemic complications (13% vs 4%; P < .0001), and mortality (6% vs 1%; P < .0001). Adjusting for demographics and comorbidities, dependent status was an independent risk factor for mortality (OR, 3.4; 95% CI; 2.0-5.5) and major complications (OR, 3.0; 95% CI, 2.4-3.8; Table II). In addition, dependent patients had longer hospital lengths of stay (4 vs 2 days; P < .0001), and higher rates of reoperation (5% vs 3%; P = .03) and readmission (4% vs 2%; P = .01; Table I). Although EVAR is a minimally invasive method of repairing AAA, preoperative functional status is the leading determinant of postoperative major morbidity and mortality. Functional status may be used as a valuable marker of increased perioperative risk, and to identify patients who may benefit from preoperative optimization.Table IPatient characteristics and outcomesIndependent (n = 13043)Dependent (n = 389)PDemographics and comorbidities Age, mean ± SD years73 ± 877 ± 880 years2.41.7-3.4