Short-term outcomes of open surgical abdominal aortic aneurysm repair from the Dutch Surgical Aneurysm Audit.
Journal
BJS open
ISSN: 2474-9842
Titre abrégé: BJS Open
Pays: England
ID NLM: 101722685
Informations de publication
Date de publication:
06 09 2021
06 09 2021
Historique:
received:
04
05
2021
accepted:
05
08
2021
entrez:
14
9
2021
pubmed:
15
9
2021
medline:
15
12
2021
Statut:
ppublish
Résumé
The sharp decrease in open surgical repair (OSR) for abdominal aortic aneurysm (AAA) has raised concerns about contemporary postoperative outcomes. The study was designed to analyse the impact of complications on clinical outcomes within 30 days following OSR. Patients who underwent OSR for intact AAA registered prospectively between 2016 and 2019 in the Dutch Surgical Aneurysm Audit were included. Complications and outcomes (death, secondary interventions, prolonged hospitalization) were evaluated. The adjusted relative risk (aRr) and 95 per cent confidence intervals were computed using Poisson regression. Subsequently, the population-attributable fraction (PAF) was calculated. The PAF reflects the expected percentage reduction of an outcome if a complication were to be completely prevented. A total of 1657 patients were analysed. Bowel ischaemia and renal complications had the largest impact on death (aRr 12·44 (95 per cent c.i. 7·95 to 19·84) at PAF 20 (95 per cent c.i. 8·4 to 31·5) per cent and aRr 5·07 (95 per cent c.i. 3·18 to 8.07) at PAF 14 (95 per cent c.i. 0·7 to 27·0) per cent, respectively). Arterial occlusion had the greatest impact on secondary interventions (aRr 11·28 (95 per cent c.i. 8·90 to 14·30) at PAF 21 (95 per cent c.i. 14·7 to 28·1) per cent), and pneumonia (aRr 2·52 (95 per cent c.i. 2·04 to 3·10) at PAF 13 (95 per cent c.i. 8·3 to 17·8) per cent) on prolonged hospitalization. Small effects were observed on outcomes for other complications. The greatest clinical impact following OSR can be made by focusing on measures to reduce the occurrence of bowel ischaemia, arterial occlusion and pneumonia.
Sections du résumé
BACKGROUND
The sharp decrease in open surgical repair (OSR) for abdominal aortic aneurysm (AAA) has raised concerns about contemporary postoperative outcomes. The study was designed to analyse the impact of complications on clinical outcomes within 30 days following OSR.
METHODS
Patients who underwent OSR for intact AAA registered prospectively between 2016 and 2019 in the Dutch Surgical Aneurysm Audit were included. Complications and outcomes (death, secondary interventions, prolonged hospitalization) were evaluated. The adjusted relative risk (aRr) and 95 per cent confidence intervals were computed using Poisson regression. Subsequently, the population-attributable fraction (PAF) was calculated. The PAF reflects the expected percentage reduction of an outcome if a complication were to be completely prevented.
RESULTS
A total of 1657 patients were analysed. Bowel ischaemia and renal complications had the largest impact on death (aRr 12·44 (95 per cent c.i. 7·95 to 19·84) at PAF 20 (95 per cent c.i. 8·4 to 31·5) per cent and aRr 5·07 (95 per cent c.i. 3·18 to 8.07) at PAF 14 (95 per cent c.i. 0·7 to 27·0) per cent, respectively). Arterial occlusion had the greatest impact on secondary interventions (aRr 11·28 (95 per cent c.i. 8·90 to 14·30) at PAF 21 (95 per cent c.i. 14·7 to 28·1) per cent), and pneumonia (aRr 2·52 (95 per cent c.i. 2·04 to 3·10) at PAF 13 (95 per cent c.i. 8·3 to 17·8) per cent) on prolonged hospitalization. Small effects were observed on outcomes for other complications.
CONCLUSION
The greatest clinical impact following OSR can be made by focusing on measures to reduce the occurrence of bowel ischaemia, arterial occlusion and pneumonia.
Identifiants
pubmed: 34518868
pii: 6369775
doi: 10.1093/bjsopen/zrab086
pmc: PMC8438252
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Investigateurs
P J van den Akker
(PJ)
G P Akkersdijk
(GP)
W L Akkersdijk
(WL)
M G van Andringa de Kempenaer
(MG)
C H P Arts
(CHP)
A M Avontuur
(AM)
O J Bakker
(OJ)
R Balm
(R)
W B Barendregt
(WB)
J A Bekken
(JA)
M H M Bender
(MHM)
B L W Bendermacher
(BLW)
M van den Berg
(M)
R J Beuk
(RJ)
J D Blankensteijn
(JD)
A S Bode
(AS)
M E Bodegom
(ME)
K E A van der Bogt
(KEA)
A P M Boll
(APM)
M H Booster
(MH)
B L S Borger van der Burg
(BLS)
G J de Borst
(GJ)
W T G J Bos- van Rossum
(WTGJ)
J Bosma
(J)
J M J Botman
(JMJ)
L H Bouwman
(LH)
V Brehm
(V)
M T de Bruijn
(MT)
J L de Bruin
(JL)
P Brummel
(P)
J P van Brussel
(JP)
S E Buijk
(SE)
M G Buimer
(MG)
H C J L Buscher
(HCJL)
E Cancrinus
(E)
P H Castenmiller
(PH)
G Cazander
(G)
Ph W M Cuypers
(PWM)
J H C Daemen
(JHC)
I Dawson
(I)
J E Dierikx
(JE)
M L Dijkstra
(ML)
J Diks
(J)
M K Dinkelman
(MK)
M Dirven
(M)
D E J G J Dolmans
(DEJGJ)
L M C van Dortmont
(LMC)
J W Drouven
(JW)
M M van der Eb
(MM)
D Eefting
(D)
G J W M van Eijck
(GJWM)
J W M Elshof
(JWM)
B H P Elsman
(BHP)
A van der Elst
(A)
M I A van Engeland
(MIA)
G S van Eps
(GS)
M J Faber
(MJ)
W M de Fijter
(WM)
B Fioole
(B)
W M Fritschy
(WM)
P H P Fung Kon Jin
(PHP)
R H Geelkerken
(RH)
W B van Gent
(WB)
G J Glade
(GJ)
B Govaert
(B)
R P R Groenendijk
(RPR)
H G W de Groot
(HGW)
R F F van den Haak
(RFF)
E F A de Haan
(EFA)
G F Hajer
(GF)
J F Hamming
(JF)
E S van Hattum
(ES)
C E V B Hazenberg
(CEVB)
P Ph A Hedeman Joosten
(PPA)
J N Helleman
(JN)
L G van der Hem
(LG)
J M Hendriks
(JM)
J A van Herwaarden
(JA)
J M M Heyligers
(JMM)
J W Hinnen
(JW)
R J Hissink
(RJ)
G H Ho
(GH)
P T den Hoed
(PT)
M T C Hoedt
(MTC)
F van Hoek
(F)
R Hoencamp
(R)
W H Hoffmann
(WH)
A W J Hoksbergen
(AWJ)
E J F Hollander
(EJF)
L C Huisman
(LC)
R G Hulsebos
(RG)
K M B Huntjens
(KMB)
M M Idu
(MM)
M J H M Jacobs
(MJHM)
M F P van der Jagt
(MFP)
J R H Jansbeken
(JRH)
R J L Janssen
(RJL)
H H L Jiang
(HHL)
S C de Jong
(SC)
T A Jongbloed-Winkel
(TA)
V Jongkind
(V)
M R Kapma
(MR)
B P J A Keller
(BPJA)
A Khodadade Jahrome
(A)
J K Kievit
(JK)
P L Klemm
(PL)
P Klinkert Jr
(P)
N A Koedam
(NA)
M J W Koelemaij
(MJW)
J L P Kolkert
(JLP)
G G Koning
(GG)
O H J Koning
(OHJ)
R Konings
(R)
A G Krasznai
(AG)
R H J Kropman
(RHJ)
R R Kruse
(RR)
L van der Laan
(L)
M J van der Laan
(MJ)
J H H van Laanen
(JHH)
G W van Lammeren
(GW)
D A A Lamprou
(DAA)
J H P Lardenoije
(JHP)
G J Lauret
(GJ)
B J M Leenders
(BJM)
D A Legemate
(DA)
V J Leijdekkers
(VJ)
M S Lemson
(MS)
M M A Lensvelt
(MMA)
M A Lijkwan
(MA)
F Th P M van der Linden
(FTPM)
P F Liqui Lung
(PF)
M J A Loos
(MJA)
M C Loubert
(MC)
K M van de Luijtgaarden
(KM)
D E A K Mahmoud
(DEAK)
C G Manshanden
(CG)
E C J L Mattens
(ECJL)
R Meerwaldt
(R)
B M E Mees
(BME)
T P Menting
(TP)
R Metz
(R)
J C A de Mol van Otterloo
(JCA)
M J Molegraaf
(MJ)
Y C A Montauban van Swijndregt
(YCA)
M J M Morak
(MJM)
R H W van de Mortel
(RHW)
W Mulder
(W)
S K Nagesser
(SK)
C C L M Naves
(CCLM)
J H Nederhoed
(JH)
A M Nevenzel
(AM)
A J de Nie
(AJ)
D H Nieuwenhuis
(DH)
R C van Nieuwenhuizen
(RC)
J Nieuwenhuizen
(J)
D Nio
(D)
A P A Oomen
(APA)
B I Oranen
(BI)
J Oskam
(J)
H W Palamba
(HW)
A G Peppelenbosch
(AG)
A S van Petersen
(AS)
B J Petri
(BJ)
M E N Pierie
(MEN)
A J Ploeg
(AJ)
R A Pol
(RA)
E D Ponfoort
(ED)
P P C Poyck
(PPC)
A Prent
(A)
S ten Raa
(S)
J T F J Raymakers
(JTFJ)
B L Reichmann
(BL)
M M P J Reijnen
(MMPJ)
J A M de Ridder
(JAM)
A Rijbroek
(A)
M J E van Rijn
(MJE)
R A de Roo
(RA)
E V Rouwet
(EV)
B R Saleem
(BR)
M R H M van Sambeek
(MRHM)
M G Samyn
(MG)
H P van't Sant
(HP)
J van Schaik
(J)
P M van Schaik
(PM)
D M Scharn
(DM)
M R M Scheltinga
(MRM)
A Schepers
(A)
P M Schlejen
(PM)
F J V Schlösser
(FJV)
F P G Schol
(FPG)
V P W Scholtes
(VPW)
O Schouten
(O)
M A Schreve
(MA)
G W H Schurink
(GWH)
C J J M Sikkink
(CJJM)
A Te Slaa
(A)
H J Smeets
(HJ)
L Smeets
(L)
R R Smeets
(RR)
A A E A de Smet
(AAEA)
P C Smit
(PC)
T M Smits
(TM)
M G J Snoeijs
(MGJ)
A O Sondakh
(AO)
M J Speijers
(MJ)
T J van der Steenhoven
(TJ)
S M M van Sterkenburg
(SMM)
D A A Stigter
(DAA)
R A Stokmans
(RA)
R P Strating
(RP)
G N M Stultiëns
(GNM)
J E M Sybrandy
(JEM)
J A W Teijink
(JAW)
B J Telgenkamp
(BJ)
M J G Testroote
(MJG)
T Tha-In
(T)
R M The
(RM)
W J Thijsse
(WJ)
I Thomassen
(I)
I F J Tielliu
(IFJ)
R B M van Tongeren
(RBM)
R J Toorop
(RJ)
E Tournoij
(E)
M Truijers
(M)
K Türkcan
(K)
R P Tutein Nolthenius
(RP)
C Ünlü
(C)
R H D Vaes
(RHD)
A C Vahl
(AC)
E J Veen
(EJ)
H T C Veger
(HTC)
M G Veldman
(MG)
H J M Verhagen
(HJM)
B A N Verhoeven
(BAN)
C F W Vermeulen
(CFW)
E G J Vermeulen
(EGJ)
B P Vierhout
(BP)
R J van der Vijver-Coppen
(RJ)
M J T Visser
(MJT)
J A van der Vliet
(JA)
C J van Vlijmen-van Keulen
(CJ)
J R van der Vorst
(JR)
A W F Vos
(AWF)
C G Vos
(CG)
G A Vos
(GA)
B de Vos
(B)
M T Voûte
(MT)
B H R Vriens
(BHR)
P W H E Vriens
(PWHE)
D K de Vries
(DK)
J P P M de Vries
(JPPM)
M de Vries
(M)
A C de Vries
(AC)
C van der Waal
(C)
E J Waasdorp
(EJ)
B M Wallis de Vries
(BM)
L A van Walraven
(LA)
J L van Wanroi
(JL)
M C Warlé
(MC)
V van Weel
(V)
A M E van Well
(AME)
G M J M Welten
(GMJM)
J J Wever
(JJ)
A M Wiersema
(AM)
O R M Wikkeling
(ORM)
W I M Willaert
(WIM)
J Wille
(J)
M C M Willems
(MCM)
E M Willigendael
(EM)
E D Wilschut
(ED)
W Wisselink
(W)
M E Witte
(ME)
C H A Wittens
(CHA)
C Y Wong
(CY)
O Yazar
(O)
K K Yeung
(KK)
C J A M Zeebregts
(CJAM)
M L P van Zeeland
(MLP)
Informations de copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.
Références
J Vasc Surg. 2014 Dec;60(6):1635-9
pubmed: 25454105
Ann Vasc Surg. 2017 Feb;39:294-300
pubmed: 27890835
Ann Vasc Surg. 2021 May;73:407-416
pubmed: 33383137
Eur J Vasc Endovasc Surg. 2017 Apr;53(4):520-532
pubmed: 28256396
Eur J Vasc Endovasc Surg. 2012 Feb;43(2):182-7
pubmed: 22178250
J Vasc Surg. 2017 Jan;65(1):257-261
pubmed: 27743805
Ann Surg. 2020 Apr;271(4):781-789
pubmed: 30216222
J Vasc Surg. 2015 Oct;62(4):1023-1031.e5
pubmed: 26143662
Am J Public Health. 1998 Jan;88(1):15-9
pubmed: 9584027
Eur J Vasc Endovasc Surg. 2017 Jul;54(1):13-20
pubmed: 28416191
Eur J Vasc Endovasc Surg. 2010 Dec;40(6):696-707
pubmed: 20889355
Lancet. 2007 Oct 20;370(9596):1453-7
pubmed: 18064739
Lancet. 2016 Nov 12;388(10058):2366-2374
pubmed: 27743617
J Vasc Surg. 2008 Aug;48(2):272-7
pubmed: 18572356
Eur J Vasc Endovasc Surg. 2012 Oct;44(4):359-67
pubmed: 22831869
Eur J Epidemiol. 2016 Jun;31(6):575-82
pubmed: 26992709
J Vasc Surg. 2018 Mar;67(3):735-739
pubmed: 28964619
Ann Epidemiol. 2015 Mar;25(3):147-54
pubmed: 25721747
Eur J Vasc Endovasc Surg. 2019 Jan;57(1):8-93
pubmed: 30528142
World J Surg. 2019 Sep;43(9):2328-2336
pubmed: 31183537
J Vasc Surg. 2014 Jun;59(6):1512-7
pubmed: 24560865
J Vasc Surg. 2016 Nov;64(5):1384-1391
pubmed: 27475466
J Vasc Surg. 2018 Sep;68(3):900-915
pubmed: 30146037
Am J Med. 2003 Oct 15;115(6):462-6
pubmed: 14563503
J Vasc Surg. 2019 Aug;70(2):629-640.e1
pubmed: 30922754
J Vasc Surg. 2018 Feb;67(2):433-440.e1
pubmed: 28943011
J Vasc Surg. 2004 Oct;40(4):691-7
pubmed: 15472596
J Vasc Surg. 2017 Mar;65(3):793-803
pubmed: 28236921
Eur J Vasc Endovasc Surg. 2011 Nov;42(5):598-607
pubmed: 21775173
Br J Surg. 2016 Jul;103(8):989-94
pubmed: 27138354
J Am Coll Surg. 2003 May;196(5):671-8
pubmed: 12742194
N Engl J Med. 2015 Jul 23;373(4):328-38
pubmed: 26200979
J Vasc Surg. 2017 Nov;66(5):1379-1389
pubmed: 29061270
N Engl J Med. 2019 May 30;380(22):2126-2135
pubmed: 31141634
Trials. 2021 Sep 19;22(1):639
pubmed: 34538275