Title

Variables Influencing Outcomes In Elective Aortic Reconstruction

Abstract

Introduction: Aortic reconstructive surgery for abdominal aortic aneurysm(AAA)and aortic occlusive disease(ABF), and combined disease (AAA/ABF)is associated with considerable morbidity and mortality. The purpose of this study was to determine variables influencing outcomes along the continuum of care as a foundation for developing an evidenced-based best practice initiative. Methods: Descriptive, comparative study of all patients with elective aortic reconstruction surgery between 10/97-12/98 on 40 variables along the continuum of care during hospitalization. Results:Data were collected on 111 patients. Subjects were grouped by type of surgery: AAA (n=36) ABF (n=48), AAA/ABF(n=27); and outcome status: survived without complications (n=76), survived with major complications (n=27), and expired (n=8). ANOVA and Chi-Square statistics were used to detect differences between groups. Tukey's post hoc analysis was done when differences were detected. Statistical significance was set at p≤.05. No statistical differences were found in outcome status by surgery type. AAA/ABF was significant for longer OR time, estimated blood loss(EBL), IV fluids, and abdominal compartment syndrome. Variables significant for outcome status included cardiac history (p=0.009), preoperative BUN (p=0.008), number of cell saver (CS)(p=0.04) and blood product units given (p=0.008), and postoperative hypotension (p=0.000). Post-operative pulmonary complications were most common(n=24,22%), followed by cardiac (n=12, 11%). Preoperative creatinine, OR time, EBL, and intraoperative IV fluids given were not significant to outcome status. Conclusions: Patients with cardiac history may benefit from preoperative hemodynamic assessment and maximization. Patients with elevated BUN on admission may be volume depleted prior to surgery and benefit from repletion prior to surgery. Monitoring for and treating postoperative hypotension may avoid perfusion deficits and organ dysfunction. Preventing and managing pulmonary and cardiac complications is important. The role of the number of CS units given during surgery to patient outcome after aortic reconstruction should be further explored.

Publication Date

1-1-1999

Publication Title

Critical Care Medicine

Volume

27

Issue

12 SUPPL.

Document Type

Article

Personal Identifier

scopus

DOI Link

https://doi.org/10.1097/00003246-199912001-00021

Socpus ID

33750643244 (Scopus)

Source API URL

https://api.elsevier.com/content/abstract/scopus_id/33750643244

This document is currently not available here.

Share

COinS