Locoregional anesthesia is associated with lower 30-day mortality than general anesthesia in patients undergoing endovascular repair of ruptured abdominal aortic aneurysm.

OBJECTIVE: The objective of this study was to compare 30-day postoperative mortality for patients undergoing endovascular repair of ruptured abdominal aortic aneurysm (rAAA) using locoregional vs general anesthesia. Unlike the open approach, endovascular repair of rAAA can be performed using either locoregional or general anesthesia. We hypothesize that mortality after endovascular repair of rAAA is lower when locoregional rather than general anesthesia is used. METHODS: Propensity score matching techniques were used to compare the 30-day postoperative outcomes of patients from the 2007 to 2015 American College of Surgeons National Surgical Quality Improvement Program database who underwent endovascular repair of rAAA under locoregional vs general anesthesia. RESULTS: Of the 1382 endovascular rAAA repair procedures in our overall study population, 132 (9.5%) were performed using locoregional anesthesia. Our propensity score matching algorithm yielded a cohort of 130 general anesthesia patients who were well matched with their locoregional anesthesia counterparts for known patient and procedure characteristics. The 30-day postoperative mortality rates for patients in the matched cohort were 14.6% for patients in the locoregional anesthesia group compared with 29.2% for patients in the general anesthesia group (P = .002). CONCLUSIONS: Locoregional rather than general anesthesia is associated with a significantly lower 30-day mortality after endovascular repair of rAAA. The designs of future trials comparing endovascular and open rAAA repair should include stratification of endovascular procedures by anesthesia modality.

Association Between Body Mass Index and Perioperative Mortality After Repair of Ruptured Abdominal Aortic Aneurysms.

OBJECTIVE: The attempt to repair a ruptured abdominal aortic aneurysm carries a significant risk of perioperative mortality. The relationship between body mass index (BMI) and outcomes after repair of ruptured abdominal aortic aneurysms (AAAs) has not been well defined. We report the association of BMI with outcomes after ruptured AAA repair. METHODS: Patients undergoing ruptured AAA repairs between 2008 and 2017 at 2 tertiary academic centers were included in this retrospective study. Demographics (including BMI), type of repair, length of stay, and admission mortality risk scores were gathered and analyzed using bivariate and multivariate logistic regressions. Adjusted odds ratio (AOR) was reported with 95% CIs and P values from the multivariate analysis. The primary outcome was 30-day mortality. Akaike information criterion (AIC) and c-statistics were used to assess the predictive power of models including physiologic score with or without BMI. RESULTS: A total of 202 patients underwent repair of ruptured AAA. In bivariate relationship, increased BMI was significantly associated with 30-day mortality. With multivariate analysis, adjusting for demographics, type of procedure, and physiologic score, for each kg/m2 increase in BMI, an 8% increase in the likelihood of perioperative mortality (AOR = 1.08, 95% CI: 1.01-1.17; P = .04) was observed. CONCLUSION: When adjusted for admission risk score, type of procedure, and demographics, obesity was associated with increased 30-day mortality. With BMI as an additional data point, the c-statistics and AIC comparisons indicated that we would have a greater ability to preoperatively estimate mortality after ruptured AAA repair. Consideration could be made to include BMI in future mortality risk scoring systems for ruptured AAA.