LATE SURVIVAL RISK-FACTORS FOR ABDOMINAL AORTIC-ANEURYSM REPAIR - EXPERIENCE FROM 14 DEPARTMENT-OF-VETERANS-AFFAIRS HOSPITALS

Background. This study evaluates late survival risk factors for patien ts who underwent elective abdominal aortic aneurysm surgical procedure s performed at 14 Department of Veterans Affairs hospitals across the United States between 1985 and 1987. Methods. Preoperative risk factor s for a representative sample of 280 male veterans were obtained from an extensive Department of Veterans Affairs office of Quality Manageme nt study and subsequent chart review. The National Death Index was use d to determine survival through December 1991. Results. Mortality at 3 0 days was 2.9%. Kaplan-Meier survival probabilities were 89% (+/-2%) at 1 year and 64% (+/-3%) at 5 years. Multivariate hazards models indi cated significantly poorer survival for patients with age greater than 69 years, chronic obstructive pulmonary disease, cerebrovascular dise ase, and left ventricular hypertrophy. A history of coronary artery di sease including previous myocardial infarction or bypass operation did not predict late survival for this cohort. Conclusions. Given the sub stantial burden of comorbidity of veterans who use Department of Veter ans Affairs facilities, the overall survival experience of this all ma b cohort compares well with previously published series and with overa ll U.S. male life expectancy. The fact that a history of coronary arte ry disease did not predict survival for this cohort may be related to selection bias; however, a more likely explanation is the presence of unsuspected coronary disease among patients without a documented histo ry of angina or myocardial infarction.