IP031. Outcomes of Contemporary Open Repair of Ruptured Abdominal Aortic Aneurysms

Owing to the promise of improved outcomes, endovascular repair of ruptured abdominal aortic aneurysms (RAAA) has become more prevalent, while open repair rates have decreased. Our goal was to assess the contemporary practice patterns and outcomes of open RAAA repair. The American College of Surgeons National Surgical Quality Improvement Program targeted open AAA database (2011-2014) was queried for all RAAA cases. Patient characteristics, presentation, aneurysm details, and operative details were analyzed to identify factors that may affect outcome in this patient population. We identified 404 patients (76.2% male) who underwent open repair of RAAA. The average age was 72 ± 9.4 years, and 230 patients (56.9%) were defined as hypotensive on presentation in the database. Surgical approach was retroperitoneal in 16.3% of cases. Proximal aneurysm extents were infrarenal (52.5%), juxtarenal (24.3%), pararenal (4.2%), and suprarenal (8.2%). Distal extent of aneurysm was aorta (38.6%), common iliac artery (34.2%), and external/internal iliac (8.9%). Renal, visceral, and lower extremity revascularization were performed in 6.4%, 2.2%, and 7.9% of patients, respectively. Thirty day mortality was 35.6% and postoperative complications included cardiac (18.3%), pulmonary (42.3%), wound infection (6.7%), acute renal failure (17.3%), and ischemic colitis (9.4%). Postoperative hospital length of stay was 13.1 ± 12.7 days, and the 30-day readmission rate was 4.5%. Transperitoneal repair (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.38-7.89; P < .001), hypotension at presentation (OR, 2.03; 95% CI, 1.2-3.56; P = .007), and age (OR, 1.05; 95% CI, 1.02-1.09; P = .001) were associated with 30-day mortality. The transperitoneal approach was also associated with increased risk of postoperative cardiac complications (OR, 3.25; 95% CI, 1.01-10.4; P = .047). Postoperative pulmonary complications were predicted by chronic obstructive pulmonary disease (OR, 2.06; 95% CI, 1.07- 3.94; P = .03) and hypotension at presentation (OR, 1.77; 95% CI, 1.06-2.96; P = .03). The majority of contemporary open RAAA procedures were performed to treat infrarenal aneurysms. Contemporary perioperative mortality rates appear to be lower than historical rates.