Document Detail


Defining high-risk patients for endovascular aneurysm repair.
MedLine Citation:
PMID:  19782526     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Endovascular aneurysm repair (EVAR) is commonly used as a minimally invasive technique for repairing infrarenal aortic aneurysms. There have been recent concerns that a subset of high-risk patients experience unfavorable outcomes with this intervention. To determine whether such a high-risk cohort exists and to identify the characteristics of these patients, we analyzed the outcomes of Medicare patients treated with EVAR from 2000-2006.
METHODS: We identified 66,943 patients who underwent EVAR from Inpatient Medicare database. The overall 30-day mortality was 1.6%. A risk model for perioperative mortality was developed by randomly selecting 44,630 patients; the other one third of the dataset was used to validate the model. The model was deemed reliable (Hosmer-Lemeshow statistics were P = .25 for the development, P = .24 for the validation model) and accurate (c = 0.735 and c = 0.731 for the development and the validation model, respectively).
RESULTS: In our scoring system, where scores ranged between 1 and 7, the following were identified as significant baseline factors that predict mortality: renal failure with dialysis (score = 7); renal failure without dialysis (score = 3); clinically significant lower extremity ischemia (score = 5); patient age >or=85 years (score = 3), 75-84 years (score = 2), 70-74 years (score = 1); heart failure (score = 3); chronic liver disease (score = 3); female gender (score = 2); neurological disorders (score = 2); chronic pulmonary disease (score = 2); surgeon experience in EVAR <3 procedures (score = 1); and hospital annual volume in EVAR <7 procedures (score = 1). The majority of Medicare patients who were treated (96.6%, n = 64,651) had a score of 9 or less, which correlated with a mortality <5%. Only 3.4% of patients had a mortality >or=5% and 0.8% of patients (n = 509) had a score of 13 or higher, which correlated with a mortality >10%.
CONCLUSION: We conclude that there is a high-risk cohort of patients that should not be treated with EVAR because of prohibitively high mortality; however, this cohort is small. Our scoring system, which is based on patient and institutional factors, provides criteria that can be easily used by clinicians to quantify perioperative risk for EVAR candidates.
Authors:
Natalia Egorova; Jeannine K Giacovelli; Annetine Gelijns; Giampaolo Greco; Alan Moskowitz; James McKinsey; K Craig Kent
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Publication Detail:
Type:  Journal Article     Date:  2009-09-26
Journal Detail:
Title:  Journal of vascular surgery     Volume:  50     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-12-04     Completed Date:  2009-12-21     Revised Date:  2014-03-19    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1271-9.e1     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal / mortality*,  surgery*
Blood Vessel Prosthesis Implantation / adverse effects,  mortality*
Female
Health Status Indicators*
Humans
Logistic Models
Male
Medicare
Odds Ratio
Patient Selection*
Predictive Value of Tests
ROC Curve
Reproducibility of Results
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States / epidemiology
Grant Support
ID/Acronym/Agency:
T32 HL007854/HL/NHLBI NIH HHS; T32 HL007854-11/HL/NHLBI NIH HHS; T32 HL007854-12/HL/NHLBI NIH HHS
Comments/Corrections
Comment In:
J Vasc Surg. 2009 Dec;50(6):1279   [PMID:  19958983 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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