Comparison of Contemporary and Historical Outcomes of Elective and Ruptured Open Abdominal Aortic Aneurysm Repair.

Abstract Introduction Recently, open AAA repair (OSR) has become less common and is often reserved for more complex aortic anatomy. Despite improvement in patient management, reduced surgical volume raises concern for potentially worsened outcomes in the contemporary era (2014-2019) compared to an earlier era where open repair was more widely practiced (2005-2010). This study compares the 30-day outcomes of open AAA repair between these two eras. Methods The American College of Surgeons National Quality Improvement Program (ACS-NSQIP) general database was queried for open AAA repair based on procedure CPT and ICD-9/10 codes. Cases were stratified into two groups based on operation year: 2005-2010 (early) and 2014-2019 (contemporary). In each era, the cases were further divided into “elective” and “ruptured” groups. Thirty-day outcomes, including mortality, major morbidity, postoperative sepsis, and unplanned reoperation were compared between the contemporary era and early era in the elective and ruptured groups, respectively. Preoperative variables with p-value less than 0.25 were adjusted for in the multivariate analysis. Results There were 3749 patients in the contemporary and 3798 in the early era who underwent elective OSR; whereas there were 1148 contemporary and 907 early era patients who underwent ruptured repair. These samples are similar sizes due to the NSQIP sampling process and our relatively strict inclusion criteria. There were fewer elderly patients and patients that smoke, hypertensive, and with dyspnea in the contemporary era in the elective and rupture cohorts. There were more patients with ASA > 3 in the elective contemporary era (39% vs 24%, p Conclusion Thirty-day mortality has worsened following open AAA repair in the elective and rupture settings despite the improvement in peri-operative management over the years. These complications likely stem from increased bleeding events and major cardiac events which are increased in the contemporary era.