Risk factors for mortality with surgery for abdominal aortic aneurysm. Short-, mid-, and long-term mortality results for intact and ruptured aneurysms

Abstract Introduction While concerns regarding mortality with surgery for intact or ruptured abdominal aortic aneurysms (IAAA or RAAA) prioritize the immediate postperative period, longer-term mortality and its risk factors are crucial for the utility of preventive surgery of IAAA and the outcome of RAAAs. We evaluated mortality risk factors for operated AAAs over a five-year period, with follow-up spanning until ten years. Method Data from all AAA operations in Swedvasc (2013-2017) were retrieved. Each patien was given a hospital endovascular repair (EVAR) proportion value (HEP), the share of EVAR used at the operating hospital for IAAAs or RAAAs. Swedeheart supplied previous episodes of cardiac insufficiency. Information of municipal homecare from the National Board of Health and Welfare counted as patient frailty. Two Cox's proportional hazards models evaluated mortality hazard ratio within three time strata (0-1/2 year, >1/2 year-3 years, and >3 years - until 10 years). On clinical grounds HEP, age, sex, lung-disease, heart-disease, renal disease, diabetes, frailty and previous cardiac insufficiency was used as prognostic factors. In addition, for IAAA urgency of the operation and for RAAA compromised circulation and loss of consciousness was used. Result Higher age, lung-disease, and frailty increased mortality for all AAAs during all three time strata. Cardiac disease, previous cardiac insufficiency, and higher HEP increased mortality for IAAA in the later two time strata but not for RAAA. Discussion Senior age, lung-disease, and frailty are dominating mortality risk factors for postoperative AAA. EVAR use increases mortality between 1/2 a year and 10 years for IAAA but not for RAAA.