Development of a risk index for prediction of mortality after open aortic aneurysm repair

Bala Ramanan, Prateek K. Gupta, Abhishek Sundaram, Himani Gupta, Jason M. Johanning, Thomas G. Lynch, Jason N. Mactaggart, Iraklis I. Pipinos

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objective: Open infrarenal abdominal aortic aneurysm (oAAA) repair is associated with significant morbidity and mortality. Although there has been a shift toward endovascular repair, many patients continue to undergo an open repair due to anatomic considerations. Tools currently existing for estimation of periprocedural risk in patients undergoing open aortic surgery have certain limitations. The objective of this study was to develop a risk index to estimate the risk of 30-day perioperative mortality after elective oAAA repair. Methods: Patients who underwent elective oAAA repair (n = 2845) were identified from the American College of Surgeons' 2007 to 2009 National Surgical Quality Improvement Program (NSQIP), a prospective database maintained at >250 centers. Univariable and multivariable analyses were performed to evaluate risk factors associated with 30-day mortality after oAAA repair and a risk index was developed. Results: The 30-day mortality after oAAA repair was 3.3%. Multivariable analysis identified six preoperative predictors of mortality, and a risk index was created by assigning weighted points to each predictor using the β-coefficients from the regression analysis. The predictors included dyspnea (at rest: 8 points; on moderate exertion: 2 points; none: 0 points), history of peripheral arterial disease requiring revascularization or amputation (3 points), age >65 years (3 points), preoperative creatinine >1.5 mg/dL (2 points), female gender (2 points), and platelets <150,000/mm3 or >350,000/mm3 (2 points). Patients were classified as low (<7%), intermediate (7%-15%), and high (>15%) risk for 30-day mortality based on a total point score of <8, 8 to 11, and >11, respectively. There were 2508 patients (88.2%) patients in the low-risk category, 278 (9.8%) in the intermediate-risk category, and 59 (2.1%) in the high-risk category. Conclusions: This risk index has excellent predictive ability for mortality after oAAA repair and awaits validation in subsequent studies. It is anticipated to aid patients and surgeons in informed patient consent, preoperative risk assessment, and optimization.

Original languageEnglish (US)
Pages (from-to)871-878
Number of pages8
JournalJournal of Vascular Surgery
Volume58
Issue number4
DOIs
StatePublished - Oct 1 2013

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Aortic Aneurysm
Abdominal Aortic Aneurysm
Mortality
Peripheral Arterial Disease
Quality Improvement
Informed Consent
Amputation
Dyspnea
Creatinine
Blood Platelets
Regression Analysis
Databases
Morbidity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Ramanan, B., Gupta, P. K., Sundaram, A., Gupta, H., Johanning, J. M., Lynch, T. G., ... Pipinos, I. I. (2013). Development of a risk index for prediction of mortality after open aortic aneurysm repair. Journal of Vascular Surgery, 58(4), 871-878. https://doi.org/10.1016/j.jvs.2013.03.024

Development of a risk index for prediction of mortality after open aortic aneurysm repair. / Ramanan, Bala; Gupta, Prateek K.; Sundaram, Abhishek; Gupta, Himani; Johanning, Jason M.; Lynch, Thomas G.; Mactaggart, Jason N.; Pipinos, Iraklis I.

In: Journal of Vascular Surgery, Vol. 58, No. 4, 01.10.2013, p. 871-878.

Research output: Contribution to journalArticle

Ramanan, B, Gupta, PK, Sundaram, A, Gupta, H, Johanning, JM, Lynch, TG, Mactaggart, JN & Pipinos, II 2013, 'Development of a risk index for prediction of mortality after open aortic aneurysm repair', Journal of Vascular Surgery, vol. 58, no. 4, pp. 871-878. https://doi.org/10.1016/j.jvs.2013.03.024
Ramanan, Bala ; Gupta, Prateek K. ; Sundaram, Abhishek ; Gupta, Himani ; Johanning, Jason M. ; Lynch, Thomas G. ; Mactaggart, Jason N. ; Pipinos, Iraklis I. / Development of a risk index for prediction of mortality after open aortic aneurysm repair. In: Journal of Vascular Surgery. 2013 ; Vol. 58, No. 4. pp. 871-878.
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abstract = "Objective: Open infrarenal abdominal aortic aneurysm (oAAA) repair is associated with significant morbidity and mortality. Although there has been a shift toward endovascular repair, many patients continue to undergo an open repair due to anatomic considerations. Tools currently existing for estimation of periprocedural risk in patients undergoing open aortic surgery have certain limitations. The objective of this study was to develop a risk index to estimate the risk of 30-day perioperative mortality after elective oAAA repair. Methods: Patients who underwent elective oAAA repair (n = 2845) were identified from the American College of Surgeons' 2007 to 2009 National Surgical Quality Improvement Program (NSQIP), a prospective database maintained at >250 centers. Univariable and multivariable analyses were performed to evaluate risk factors associated with 30-day mortality after oAAA repair and a risk index was developed. Results: The 30-day mortality after oAAA repair was 3.3{\%}. Multivariable analysis identified six preoperative predictors of mortality, and a risk index was created by assigning weighted points to each predictor using the β-coefficients from the regression analysis. The predictors included dyspnea (at rest: 8 points; on moderate exertion: 2 points; none: 0 points), history of peripheral arterial disease requiring revascularization or amputation (3 points), age >65 years (3 points), preoperative creatinine >1.5 mg/dL (2 points), female gender (2 points), and platelets <150,000/mm3 or >350,000/mm3 (2 points). Patients were classified as low (<7{\%}), intermediate (7{\%}-15{\%}), and high (>15{\%}) risk for 30-day mortality based on a total point score of <8, 8 to 11, and >11, respectively. There were 2508 patients (88.2{\%}) patients in the low-risk category, 278 (9.8{\%}) in the intermediate-risk category, and 59 (2.1{\%}) in the high-risk category. Conclusions: This risk index has excellent predictive ability for mortality after oAAA repair and awaits validation in subsequent studies. It is anticipated to aid patients and surgeons in informed patient consent, preoperative risk assessment, and optimization.",
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AU - Ramanan, Bala

AU - Gupta, Prateek K.

AU - Sundaram, Abhishek

AU - Gupta, Himani

AU - Johanning, Jason M.

AU - Lynch, Thomas G.

AU - Mactaggart, Jason N.

AU - Pipinos, Iraklis I.

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N2 - Objective: Open infrarenal abdominal aortic aneurysm (oAAA) repair is associated with significant morbidity and mortality. Although there has been a shift toward endovascular repair, many patients continue to undergo an open repair due to anatomic considerations. Tools currently existing for estimation of periprocedural risk in patients undergoing open aortic surgery have certain limitations. The objective of this study was to develop a risk index to estimate the risk of 30-day perioperative mortality after elective oAAA repair. Methods: Patients who underwent elective oAAA repair (n = 2845) were identified from the American College of Surgeons' 2007 to 2009 National Surgical Quality Improvement Program (NSQIP), a prospective database maintained at >250 centers. Univariable and multivariable analyses were performed to evaluate risk factors associated with 30-day mortality after oAAA repair and a risk index was developed. Results: The 30-day mortality after oAAA repair was 3.3%. Multivariable analysis identified six preoperative predictors of mortality, and a risk index was created by assigning weighted points to each predictor using the β-coefficients from the regression analysis. The predictors included dyspnea (at rest: 8 points; on moderate exertion: 2 points; none: 0 points), history of peripheral arterial disease requiring revascularization or amputation (3 points), age >65 years (3 points), preoperative creatinine >1.5 mg/dL (2 points), female gender (2 points), and platelets <150,000/mm3 or >350,000/mm3 (2 points). Patients were classified as low (<7%), intermediate (7%-15%), and high (>15%) risk for 30-day mortality based on a total point score of <8, 8 to 11, and >11, respectively. There were 2508 patients (88.2%) patients in the low-risk category, 278 (9.8%) in the intermediate-risk category, and 59 (2.1%) in the high-risk category. Conclusions: This risk index has excellent predictive ability for mortality after oAAA repair and awaits validation in subsequent studies. It is anticipated to aid patients and surgeons in informed patient consent, preoperative risk assessment, and optimization.

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