Yonsei Med J.  2011 Mar;52(2):339-346. 10.3349/ymj.2011.52.2.339.

Risk Factors for Postoperative Complications after Open Infrarenal Abdominal Aortic Aneurysm Repair in Koreans

• Kim GS
• Ahn HJ
• Kim WH
• Kim MJ
• Lee SH

• KMID: 1779673
• DOI: http://doi.org/10.3349/ymj.2011.52.2.339

Abstract

PURPOSE
Open infrarenal abdominal aortic aneurysm (AAA) repair is performed without event in most cases. However, some patients suffer major morbidities such as renal failure, myocardial infarction, paraplegia, acute respiratory distress syndrome, or hepatic dysfunction. Predicting what kinds of patient populations are more prone to develop such complications may keep the clinicians more attentive to the patients, possibly leading to better prognoses. In this retrospective study, we searched the incidence of and risk factors for postoperative complications and their predictive equations in 162 patients who underwent open infrarenal AAA repair.
MATERIALS AND METHODS
Postoperative complications were observed within 30 days. Patient characteristics, types of aneurysm and surgery, and hemodynamic and metabolic variables during the periclamp period were analyzed in relation to postoperative complications using multiple logistic regression analysis.
RESULTS
Postoperative complications involved the cardiac (20%), pulmonary (14%), renal (13%), gastrointestinal (6%), hepatic (3.1%), and neurologic (2.5%) systems, and bleeding occurred in 1.2% of cases. The mortality rate was 5.6%. The risk factors were age [> 67 yrs, odds ratio (OR) 2.6], clamp duration (> 110 min, OR 4.7), volume of blood transfusion (> 1,280 mL, OR 4.4), emergency operation (OR 1.4), and vasopressor infusion during clamp (OR 1.4). The prediction model was: P(x) = exp(alpha)/[1 + exp(alpha)] alpha;-2.2 + 0.9 x age + 1.5 x clamp duration + 1.5 x transfusion + 0.3 x emergency + 0.4 x vasopressor infusion [insert 1 if risk factors exist, otherwise, insert 0 to each variable].
CONCLUSION
A significant number of complications occurred after infrarenal AAA repair. Therefore, creating a protocol to identify and monitor high risk patients would improve postoperative care.

Keyword

Complications; infrarenal aortic aneurysm; risk factors

MeSH Terms

Age Factors
Aged
Aortic Aneurysm, Abdominal/*surgery
Blood Loss, Surgical
Chi-Square Distribution
Female
Humans
Logistic Models
Male
Odds Ratio
Postoperative Complications/*etiology
Republic of Korea
Retrospective Studies
Risk Factors
Statistics, Nonparametric

Figure

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  Fig. 1 Flow diagram of patient inclusion.

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  Fig. 2 Hemodynamic changes during the operation. SBP, systolic blood pressure; DBP, diastolic blood pressure; HR, heart rate; CVP, central venous pressure; Declamp 5, 5 min after declamp; Declamp 10, 10 min after declamp; BPM, beat per minute. *p < 0.05 compared to Preop. †p < 0.05 compared to Preclamp. ‡p < 0.05 compared to Predeclamp. §p < 0.05 campared to Declamp 5.

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  Fig. 3 Box plot of LDH, CK, and CKMB. *p < 0.05 compard to PreOP. LDH, lactate dehydorgenase; CK, creatine kinase; CKMB, creatine kinase isoenzyme.

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  Fig. 4 The area under the receiver operating characteristic (ROC) curve. The AUC value was 0.78 (95% CI 0.71-0.85) for this model. AUC, area under the curve; CI, confidence interval.

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