Experience in the United States with intact abdominal aortic aneurysm repair

Objectives: The purpose of this study was to determine the current outcome in the United States and to identify predictors of mortality and "bad outco me" after open, intact abdominal aortic aneurysm (AAA) repair. Methods: In a retrospective analysis, data were obtained from the Nationwid e Inpatient Sample during 1994-1996. The Nationwide Inpatient Sample is a 2 0% all-payer stratified sample of nonfederal United States hospitals. Patie nts older than 49 years were identified by the presence of primary diagnost ic (441.4-intact AAA) and procedure (38.44-resection of abdominal aorta wit h replacement) codes of the International Classification of Diseases, Ninth Revision (ICD-9). In-hospital mortality rate, discharge disposition, bad o utcome (death or discharge to an institution), complications (ICD-9 postope rative codes), length of stay, and charges were determined. The mortality r ate and bad outcome were analyzed by the use of patient demographics (age, sex, race), patient comorbidities (ICD-9 diagnostic codes), calendar year, and hospital characteristics (size, location, teaching status) with univari ate and multivariate analyses. Results: We identified 16,450 intact AAAs repairs during the study years. T he mean patient age was 72 +/- 7 (+/- SD) years, and most patients were mal e (79.7%) and white (94.6%). Most repairs were performed at large (67.3%), urban (92.5%), and nonteaching (66.7%) institutions. The in-hospital mortal ity rate was 4.2%, the overall complication rate was 32.4%, and 91.2% of pa tients were discharged home, whereas the bad outcome rate was 12.6%. The me dian length of stay was 8 days (mean, 10.0 +/- 8.1), and median hospital ch arges were $28,052 (mean, $35,681 +/- $33,006) in 1996 dollars. Multivariat e analysis showed that the mortality rate (P < .05) increased with age (70- 79 years, 1.8 odds ratio [OR] [95% CI, 1.4-2.3], > 79 years, 3.8 OR [95% CI , 2.9-4.91), sex (female, 1.6 OR [95% CI, 1.3-1.9]), cerebral vascular occl usive disease (1.8 OR [95% CI, 1.3-2.5]), preoperative renal insufficiency (9.5 OR [95% CI, 7.7-11.7]), and more than three comorbidities (11.2 OR [95 % CI, 3.6-35.4]). Multivariate analysis also showed that bad outcome was as sociated with the same variables in addition to hospital size (small/medium ), year of procedure (1996), chronic obstructive pulmonary disease, and two to three comorbidities. Conclusions Outcome after open repair of intact AAA across the United State s is quite good. Older, sicker patients may benefit from nonoperative treat ment or the potentially lower risk endovascular approaches.