Optimal selection of patients for elective abdominal aortic aneurysm repair based on life expectancy

Randall R De Martino, Philip P. Goodney, Brian W. Nolan, William P. Robinson, Alik Farber, Virendra I. Patel, David H. Stone, Jack L. Cronewett

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Objective: Elective abdominal aortic aneurysm (AAA) repair is beneficial when rupture is likely during a patient's expected lifetime. The purpose of this study was to identify predictors of long-term mortality after elective AAA repair for moderately sized AAAs (<6.5-cm diameter) to identify patients unlikely to benefit from surgery. Methods: We analyzed 2367 elective infrarenal AAA (<6.5 cm) repairs across 21 centers in New England from 2003 to 2011. Our main outcome measure was 5-year life-table survival. Cox proportional hazards analysis was used to describe associations between patient characteristics and 5-year survival. Results: During the study period, 1653 endovascular AAA repairs and 714 open AAA repairs were performed. Overall, 5-year survival rates were similar by procedure type (75% endovascular repair, 80% open repair; P =.14). Advanced age ≥75 years (hazard ratio [HR], 2.0; P <.01) and age >80 years (HR, 2.6; P <.01), coronary artery disease (HR, 1.4; P <.04), unstable angina or recent myocardial infarction (HR, 4.6; P <.01), oxygen-dependent chronic obstructive pulmonary disease (HR, 2.7; P <.01), and estimated glomerular filtration rate <30 mL/min/1.73 m2 (HR, 2.8; P <.01) were associated with poor survival. Aspirin (HR, 0.8; P <.03) and statin (HR, 0.7; P <.01) use were associated with improved survival. We used these risk factors to develop risk strata for low-risk, medium-risk, and high-risk groups with survival, respectively, of 85%, 69%, and 43% at 5 years (P <.001). Conclusions: More than 75% of patients with moderately sized AAAs who underwent elective repair in our region survived 5 years, but 4% were at high risk for 5-year mortality. Patients with multiple risk factors, especially age >80 years, unstable angina, oxygen-dependent chronic obstructive pulmonary disease, and estimated glomerular filtration rate <30 mL/min/1.73 m2, are unlikely to achieve sufficient long-term survival to benefit from surgery, unless their AAA rupture risk is very high.

Original languageEnglish (US)
Pages (from-to)589-595
Number of pages7
JournalJournal of Vascular Surgery
Volume58
Issue number3
DOIs
StatePublished - Sep 2013
Externally publishedYes

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Abdominal Aortic Aneurysm
Life Expectancy
Patient Selection
Aortic Rupture
Unstable Angina
Glomerular Filtration Rate
Chronic Obstructive Pulmonary Disease
Rupture
Oxygen
Survival
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

De Martino, R. R., Goodney, P. P., Nolan, B. W., Robinson, W. P., Farber, A., Patel, V. I., ... Cronewett, J. L. (2013). Optimal selection of patients for elective abdominal aortic aneurysm repair based on life expectancy. Journal of Vascular Surgery, 58(3), 589-595. https://doi.org/10.1016/j.jvs.2013.03.010

Optimal selection of patients for elective abdominal aortic aneurysm repair based on life expectancy. / De Martino, Randall R; Goodney, Philip P.; Nolan, Brian W.; Robinson, William P.; Farber, Alik; Patel, Virendra I.; Stone, David H.; Cronewett, Jack L.

In: Journal of Vascular Surgery, Vol. 58, No. 3, 09.2013, p. 589-595.

Research output: Contribution to journalArticle

De Martino, RR, Goodney, PP, Nolan, BW, Robinson, WP, Farber, A, Patel, VI, Stone, DH & Cronewett, JL 2013, 'Optimal selection of patients for elective abdominal aortic aneurysm repair based on life expectancy', Journal of Vascular Surgery, vol. 58, no. 3, pp. 589-595. https://doi.org/10.1016/j.jvs.2013.03.010
De Martino, Randall R ; Goodney, Philip P. ; Nolan, Brian W. ; Robinson, William P. ; Farber, Alik ; Patel, Virendra I. ; Stone, David H. ; Cronewett, Jack L. / Optimal selection of patients for elective abdominal aortic aneurysm repair based on life expectancy. In: Journal of Vascular Surgery. 2013 ; Vol. 58, No. 3. pp. 589-595.
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title = "Optimal selection of patients for elective abdominal aortic aneurysm repair based on life expectancy",
abstract = "Objective: Elective abdominal aortic aneurysm (AAA) repair is beneficial when rupture is likely during a patient's expected lifetime. The purpose of this study was to identify predictors of long-term mortality after elective AAA repair for moderately sized AAAs (<6.5-cm diameter) to identify patients unlikely to benefit from surgery. Methods: We analyzed 2367 elective infrarenal AAA (<6.5 cm) repairs across 21 centers in New England from 2003 to 2011. Our main outcome measure was 5-year life-table survival. Cox proportional hazards analysis was used to describe associations between patient characteristics and 5-year survival. Results: During the study period, 1653 endovascular AAA repairs and 714 open AAA repairs were performed. Overall, 5-year survival rates were similar by procedure type (75{\%} endovascular repair, 80{\%} open repair; P =.14). Advanced age ≥75 years (hazard ratio [HR], 2.0; P <.01) and age >80 years (HR, 2.6; P <.01), coronary artery disease (HR, 1.4; P <.04), unstable angina or recent myocardial infarction (HR, 4.6; P <.01), oxygen-dependent chronic obstructive pulmonary disease (HR, 2.7; P <.01), and estimated glomerular filtration rate <30 mL/min/1.73 m2 (HR, 2.8; P <.01) were associated with poor survival. Aspirin (HR, 0.8; P <.03) and statin (HR, 0.7; P <.01) use were associated with improved survival. We used these risk factors to develop risk strata for low-risk, medium-risk, and high-risk groups with survival, respectively, of 85{\%}, 69{\%}, and 43{\%} at 5 years (P <.001). Conclusions: More than 75{\%} of patients with moderately sized AAAs who underwent elective repair in our region survived 5 years, but 4{\%} were at high risk for 5-year mortality. Patients with multiple risk factors, especially age >80 years, unstable angina, oxygen-dependent chronic obstructive pulmonary disease, and estimated glomerular filtration rate <30 mL/min/1.73 m2, are unlikely to achieve sufficient long-term survival to benefit from surgery, unless their AAA rupture risk is very high.",
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T1 - Optimal selection of patients for elective abdominal aortic aneurysm repair based on life expectancy

AU - De Martino, Randall R

AU - Goodney, Philip P.

AU - Nolan, Brian W.

AU - Robinson, William P.

AU - Farber, Alik

AU - Patel, Virendra I.

AU - Stone, David H.

AU - Cronewett, Jack L.

PY - 2013/9

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N2 - Objective: Elective abdominal aortic aneurysm (AAA) repair is beneficial when rupture is likely during a patient's expected lifetime. The purpose of this study was to identify predictors of long-term mortality after elective AAA repair for moderately sized AAAs (<6.5-cm diameter) to identify patients unlikely to benefit from surgery. Methods: We analyzed 2367 elective infrarenal AAA (<6.5 cm) repairs across 21 centers in New England from 2003 to 2011. Our main outcome measure was 5-year life-table survival. Cox proportional hazards analysis was used to describe associations between patient characteristics and 5-year survival. Results: During the study period, 1653 endovascular AAA repairs and 714 open AAA repairs were performed. Overall, 5-year survival rates were similar by procedure type (75% endovascular repair, 80% open repair; P =.14). Advanced age ≥75 years (hazard ratio [HR], 2.0; P <.01) and age >80 years (HR, 2.6; P <.01), coronary artery disease (HR, 1.4; P <.04), unstable angina or recent myocardial infarction (HR, 4.6; P <.01), oxygen-dependent chronic obstructive pulmonary disease (HR, 2.7; P <.01), and estimated glomerular filtration rate <30 mL/min/1.73 m2 (HR, 2.8; P <.01) were associated with poor survival. Aspirin (HR, 0.8; P <.03) and statin (HR, 0.7; P <.01) use were associated with improved survival. We used these risk factors to develop risk strata for low-risk, medium-risk, and high-risk groups with survival, respectively, of 85%, 69%, and 43% at 5 years (P <.001). Conclusions: More than 75% of patients with moderately sized AAAs who underwent elective repair in our region survived 5 years, but 4% were at high risk for 5-year mortality. Patients with multiple risk factors, especially age >80 years, unstable angina, oxygen-dependent chronic obstructive pulmonary disease, and estimated glomerular filtration rate <30 mL/min/1.73 m2, are unlikely to achieve sufficient long-term survival to benefit from surgery, unless their AAA rupture risk is very high.

AB - Objective: Elective abdominal aortic aneurysm (AAA) repair is beneficial when rupture is likely during a patient's expected lifetime. The purpose of this study was to identify predictors of long-term mortality after elective AAA repair for moderately sized AAAs (<6.5-cm diameter) to identify patients unlikely to benefit from surgery. Methods: We analyzed 2367 elective infrarenal AAA (<6.5 cm) repairs across 21 centers in New England from 2003 to 2011. Our main outcome measure was 5-year life-table survival. Cox proportional hazards analysis was used to describe associations between patient characteristics and 5-year survival. Results: During the study period, 1653 endovascular AAA repairs and 714 open AAA repairs were performed. Overall, 5-year survival rates were similar by procedure type (75% endovascular repair, 80% open repair; P =.14). Advanced age ≥75 years (hazard ratio [HR], 2.0; P <.01) and age >80 years (HR, 2.6; P <.01), coronary artery disease (HR, 1.4; P <.04), unstable angina or recent myocardial infarction (HR, 4.6; P <.01), oxygen-dependent chronic obstructive pulmonary disease (HR, 2.7; P <.01), and estimated glomerular filtration rate <30 mL/min/1.73 m2 (HR, 2.8; P <.01) were associated with poor survival. Aspirin (HR, 0.8; P <.03) and statin (HR, 0.7; P <.01) use were associated with improved survival. We used these risk factors to develop risk strata for low-risk, medium-risk, and high-risk groups with survival, respectively, of 85%, 69%, and 43% at 5 years (P <.001). Conclusions: More than 75% of patients with moderately sized AAAs who underwent elective repair in our region survived 5 years, but 4% were at high risk for 5-year mortality. Patients with multiple risk factors, especially age >80 years, unstable angina, oxygen-dependent chronic obstructive pulmonary disease, and estimated glomerular filtration rate <30 mL/min/1.73 m2, are unlikely to achieve sufficient long-term survival to benefit from surgery, unless their AAA rupture risk is very high.

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