Muhammad Faateh

Statins reduce mortality and failure to rescue after carotid artery stenting

Objective: The benefit of statins has been well established in reducing morbidities and mortality after carotid endarterectomy. However, the potential advantage of statin use in patients undergoing carotid artery stenting (CAS) remains largely unknown. The purpose of this study was to evaluate the effect of statins on postoperative outcomes after CAS. Methods: The Premier Healthcare Database was retrospectively analyzed to identify all patients who underwent CAS from 2009 to 2015. Univariate (χ2 test, t‐test) and multivariate models (logistic regression) were used to evaluate the effect of statins on postoperative outcomes. Results: A total of 17,800 patients underwent CAS during the study period; 12,416 (70%) patients were taking statins. The statin group had more symptomatic patients (41% vs 31%; P < .001) and had significantly higher comorbidities including hypertension, diabetes, coronary artery disease, dyslipidemia, history of congestive heart failure, history of stroke, history of myocardial infarction (MI), and peripheral artery disease (all P < .05). Postoperative mortality was 1.0% vs 1.8% in the statin and nonstatin groups, respectively (P < .001). Statin use had no effect on odds of postoperative stroke (odds ratio [OR], 1.09; 95% confidence interval [CI], 0.88‐1.34; P = .44) and higher odds of MI (OR, 2.08; 95% CI, 1.26‐3.45; P = .004). After adjustment for potential confounders, statins were associated with 64% reduction in the odds of death (OR, 0.36; 95% CI, 0.27‐0.47; P < .001) and 18% reduction in stroke/death (OR, 0.82; 95% CI, 0.68‐0.99; P = .03). In patients who had a stroke or MI, statin users had significantly lower failure to rescue (lower mortality) compared with nonstatin users (11.4% vs 30.8%; P < .001). Conclusions: Statin use is associated with significant reduction in mortality and failure to rescue in patients who develop major complications (stroke/MI) after CAS. Therefore, statin use should be strongly encouraged in all patients undergoing CAS.

Outcomes after elective abdominal aortic aneurysm repair in obese versus nonobese patients

Objective: Obesity is a worldwide epidemic, particularly in Western society. It predisposes surgical patients to an increased risk of adverse outcomes. The aim of our study was to use a nationally representative vascular database and to compare in‐hospital outcomes in obese vs nonobese patients undergoing elective open aortic repair (OAR) and endovascular aneurysm repair (EVAR). Methods: All patients undergoing elective abdominal aortic aneurysm repair were identified in the Vascular Quality Initiative database (2003‐2017). Obesity was defined as body mass index ≥30 kg/m2. Univariable (Student t‐test and χ2 test) and multivariable (logistic regression) analyses were implemented to compare in‐hospital mortality and any major complications (wound infection, renal failure, and cardiopulmonary failure) in obese vs nonobese patients. Results: We identified a total of 33,082 patients undergoing elective OAR (nonobese, n = 4605 [72.4%]; obese, n = 1754 [27.6%]) and EVAR (nonobese, n = 18,338 [68.6%]; obese, n = 8385 [31.4%]). Obese patients undergoing OAR and EVAR were relatively younger compared with nonobese patients (mean age [standard deviation], 67.55 [8.26] years vs 70.27 [8.30] years and 71.06 [8.22] years vs 74.55 [8.55] years), respectively; (both P < .001). Regardless of approach, obese patients had slightly longer operative time (OAR, 259.02 [109.97] minutes vs 239.37 [99.78] minutes; EVAR, 138.27 [70.64] minutes vs 134.34 [69.98] minutes) and higher blood loss (OAR, 2030 [1823] mL vs 1619 [1642] mL; EVAR, 228 [354] mL vs 207 [312] mL; both P < .001). There was no significant difference in mortality between the two groups undergoing OAR and EVAR (OAR, 2.9% vs 3.2% [P = .50]; EVAR, 0.5% vs 0.6% [P = .76]). On multivariable analysis, obese patients undergoing OAR had 33% higher odds of renal failure (adjusted odds ratio [OR], 1.33; 95% confidence interval [CI], 1.09‐1.63; P = .006) and 75% higher odds of wound infections (adjusted OR, 1.75; 95% CI, 1.11‐2.76; P = .02) compared with nonobese patients. However, in patients undergoing EVAR, no association was seen between obesity and any major complications. A significant interaction was found between obesity and surgical approach in the event of renal failure, in which obese patients undergoing OAR had significantly higher odds of renal failure compared with those in the EVAR group (ORinteraction, 1.36; 95% CI, 1.05‐1.75; P = .02). Conclusions: Using a large nationally representative database, we demonstrated an increased risk of renal failure and wound infections in obese patients undergoing OAR compared with nonobese patients. On the other hand, obesity did not seem to increase the odds of major adverse outcomes in patients undergoing EVAR. Further long‐term prospective studies are needed to verify the effects of obesity after abdominal aortic aneurysm repair and the implications of these findings in clinical decision‐making.

Outcomes and cost of fenestrated versus standard endovascular repair of intact abdominal aortic aneurysm in the United States

Background Fenestrated endovascular aneurysm repair (FEVAR) has expanded the indications of this minimally invasive procedure to include patients with pararenal aneurysms. The actual cost of this relatively newer technology compared with standard endovascular aneurysm repair (EVAR) has not been studied before. Thus, the aim of this study was to analyze in‐hospital costs and adverse outcomes in patients undergoing FEVAR vs EVAR for intact abdominal aortic aneurysms (AAAs). Methods Using the Premier Healthcare Database (2012‐2015), we identified all patients who underwent elective EVAR and FEVAR. Univariable (χ2 test, Student t‐test, median test) and multivariable (logistic regression and generalized linear modeling) analyses were implemented to examine in‐hospital cost and adverse outcomes adjusting for patients’ demographics, comorbidities, and regional characteristics. Results A total of 17,689 elective endovascular AAA repairs were performed; 1641 patients underwent FEVAR (9%), and the remaining 16,048 patients underwent standard EVAR (91%). Patients undergoing FEVAR were more likely to be white (86.3% vs 84.3%; P = .03). Both groups had similar comorbidities except for cerebrovascular disease, which was higher among patients undergoing FEVAR (8.4% vs 6.7%; P = .01). The total length of hospital stay was slightly higher in patients undergoing FEVAR compared with EVAR (mean [standard deviation], 2.40 [3.39] days vs 2.23 [3.10] days; P = .03). The rates of any complication (11.3% vs 9.6%), renal injury (5.8% vs 4.3%), and neurologic injury (0.7% vs 0.4%) were significantly higher in the FEVAR group (all P < .05). No differences were seen in mortality (0.8% vs 0.5%) or cardiac (4.9% vs 4.4%), pulmonary (2.4% vs 2.2%), and bowel (1.5% vs 1.2%) complications between the two groups (all P > .05). In multivariable logistic regression analysis, FEVAR was associated with 40% increased odds of renal failure (odds ratio, 1.40; 95% confidence interval [CI], 1.11‐1.76; P = .004) and 91% increased odds of neurologic injury (odds ratio, 1.91; 95% CI, 1.02‐3.57; P = .04). The median total cost of the treatment was also significantly higher among patients undergoing FEVAR (

Abstract P11. Craniosynostosis Surgery: A Painless Procedure? A Single Institution’s Experience in Post-operative Pain Management

28,227 vs

PC112 Statins Reduce Mortality and Failure to Rescue Following Carotid Artery Stenting

26,781; P < .001). After adjustment, generalized linear modeling analysis showed that the cost of FEVAR was on average

IP013. Octogenarians Undergoing Open Repair Have Higher Mortality Compared to Fenestrated Endovascular Repair of Intact Abdominal Aortic Aneurysms Involving Visceral Vessels

1612 higher than the cost of EVAR (adjusted cost,

Risks Associated With Primary and Redo Carotid Endarterectomy in the Endovascular Era

1612; 95% CI,

Racial disparities after infrainguinal bypass surgery in hemodialysis patients

1123‐

Abstract 17: 40 LE FORT FRACTURES IN CHILDREN - DO THEY EXIST?

2101; P < .001). Conclusions In this large cohort of elective endovascular AAA repairs, compared with standard EVAR, FEVAR is associated with significantly increased odds of renal and neurologic injury. In addition, despite adjusting for patients’ demographics, comorbidities, and major complications, total cost of FEVAR was significantly higher compared with standard EVAR. This is likely driven by the additional cost of fenestrated endografts and by the increased rate of complications related to FEVAR.

Pediatric Zygomaticomaxillary Complex Fracture Repair: Location and Number of Fixation Sites in Growing Children.

RESULTS: A total of 46,617 patients with orofacial clefts were identified, 14.6% with isolated cleft lip (CL), 51.7% with cleft lip and palate (CLP), and 33.7% with isolated cleft palate (CP). The incidence of patients requiring EFA increased from 2000 (3.7%) to 2012 (5.8%) (p<0.001). After controlling for comorbidities, the incidence was again found to increase throughout the study period (3.3% to 5.0%, p<0.001). Patients with comorbidities were noted to have higher rates of EFA that increase significantly between 2000 and 2012 (12.8% to 18.6%, p=0.019). Treatment in an urban teaching hospital was an independent risk factor for EFA (OR 4.65). Race and income were not independent risk factors.