Morbidity and Mortality Associated with Open Repair of Visceral Aneurysms.

Abstract

BACKGROUND\nThe Society for Vascular Surgery (SVS) recently published clinical practice guidelines on the management of visceral aneurysms. However, studies investigating perioperative outcomes of open repair of visceral aneurysms have been limited to single-center experiences with variable results that span multiple decades. This study sought to detail the morbidity and mortality associated with open repair of visceral aneurysms using a national database in the contemporary era.\n\n\nMETHODS\nNational Surgical Quality Improvement Program data, years 2013-2019, were queried for patients who underwent open repair of visceral aneurysms, which were classified as mesenteric, renal, or splenic by Current Procedural Terminology and International Classification of Diseases codes. The primary endpoint was the composite of major complication (cardiovascular, pulmonary, progressive renal failure, deep wound infection, return to OR, sepsis) and 30-day mortality. Logistic regression was used to identify predictors of the primary endpoint for nonruptured aneurysm cases.\n\n\nRESULTS\nThere were 263 nonruptured aneurysms (137 mesenteric, 66 renal, and 60 splenic) and 41 ruptured aneurysms (24 mesenteric, 1 renal, and 16 splenic) that underwent open repair. For nonruptured aneurysms, mean age was 59.4±14.7 years and 48.3% were female. In nonruptured cases, the 30-day mortality was 1.9% and major complication rate was 12.9%; return to OR (5.3%) and prolonged ventilator support (3.8%) were particularly common. As expected, rupture was associated with significantly higher mortality (22.0%, P <0.001) and major complication rate (34.1%, P=0.001). Postoperative transfusion was common in the elective group but significantly higher in the ruptured group (24.3% vs. 80.5%; p<0.001). Predictors of the primary outcome in nonruptured aneurysms include male sex (OR 2.93; 95%CI 1.28-6.7; p=0.011), anticoagulation (not discontinued prior to surgery) or bleeding disorder (OR 4.52; 95%CI 1.37-14.7; p=0.012), and albumin<3.0 g/dl (OR 4.66; 95%CI 1.17-18.6; p=0.029). Neither age nor aneurysm location were significant risk factors.\n\n\nCONCLUSION\nOpen repair of visceral aneurysms is associated with acceptable morbidity and mortality, and these risks are significantly greater once ruptured. Male sex, bleeding risk, and low albumin are all risk factors for adverse events and should be taken into consideration for operative planning and postoperative care.