Mortality and paraplegia after thoracoabdominal aortic aneurysm repair: A risk factor analysis

Background. Recent recommendations regarding thoracoabdominal aortic aneury sm (TAAA) management have emphasized individualized treatment based on bala ncing a patient's calculated risk of rupture with their anticipated risk of postoperative death or paraplegia. The purpose of this study was to enhanc e this risk-benefit decision by providing contemporary results and determin ing which preoperative risk factors currently predict mortality and paraple gia after TAAA surgery. Methods. Risk factor analyses based on data regarding 1,220 consecutive pat ients undergoing TAAA repair from 1986 through 1998 were performed using mu ltiple logistic regression with step-wise model selection. Results. The 30-day mortality rate was 4.8% (58 of 1,220) and the incidence of paraplegia was 4.6% (56 of 1,206). For elective cases, predictors of op erative mortality included renal insufficiency (p = 0.0001), increasing age (p = 0.0005), symptomatic aneurysms (p = 0.0059), and extent II aneurysms (p = 0.0054). Extent II aneurysms (p = 0.0023) and diabetes (p = 0.0402) we re predictors of paraplegia. Conclusions. These risk models may assist in decisions regarding elective T AAA operations. For patients who are acceptable candidates, contemporary su rgical management provides favorable results. (C) 2000 by The Society of Th oracic Surgeons.