PC056 Loss of Independence, Complications, and Death after Discharge after Endovascular Abdominal Aortic Aneurysm Repair

Loss of independence after surgery has been shown to increase mortality and readmission in geriatric patients. We studied loss of independence in patients undergoing endovascular abdominal aortic aneurysm (AAA) repair (EVAR). A total of 16,007 patients undergoing EVAR from 2012 to 2014 in the National Surgical Quality Improvement Program database were analyzed. Comorbidities, including preoperative functional status, were obtained. Primary outcomes were loss of independence, complications, and death after discharge. Data were analyzed using χ2, Student t-test, and multivariable analysis. Elective AAA repair was performed in 16,007 patients. There was more loss of independence in patients who had complications after EVAR (23.7%) and open repair (24.94%) than in patients who did not have complications (P < .01). There was more pneumonia (9.51% vs 1.21%; P < .01), bleeding requiring transfusion (51.03% vs 16.24%; P < .01), prolonged intubation (14.84% vs 0.85%; P < .01), renal failure (5.99% vs .50%; P < .01), and sepsis (3.86% vs .63%; P < .01) in patients who had loss of independence after any abdominal aortic surgery. History of cerebrovascular accident (odds ratio [OR], 3.15; confidence interval [CI], 1.59-6.25), complication after surgery (OR, 3.95; CI, 3.45-4.51), female (OR, 1.79; CI, 1.59-2.03), age ≥75 years (OR, 2.2; CI, 1.95-2.49), emergency surgery (OR, 2.24; CI, 1.82-2.77), and coronary artery disease (OR, 1.59; CI, 1.16-2.18) were associated with increased likelihood of loss of independence. Risk factors for death after discharge included complication (OR, 4.38; CI, 2.65-7.24), coronary artery disease (OR, 3.39; CI, 1.75-6.59), emergency surgery (OR, 3.62; CI, 2.08-6.29), unplanned readmission (OR, 3.19; CI, 1.87-5.44), and EVAR (OR, 1.87; CI, 1.11-3.14). Preoperative functional status is a strong predictor of postoperative outcomes. There is decreased loss of independence after EVAR than open repair when the procedure is without complications. However the benefits of EVAR compared to open surgery are lost when there is a complication. Loss of independence can be decreased by minimizing these complications.