A new predictive model for adverse outcomes after elective thoracoabdominal aortic aneurysm repair

Background. Recent recommendations have emphasized individualized treatment based on balancing a patient's risk of thoracoabdominal aortic aneurysm ru pture with the risk of an adverse outcome after surgical repair. The purpos e of this study was to determine which preoperative risk factors currently predict an adverse outcome after elective thoracoabdominal aortic aneurysm repair. Methods. A single, composite end point termed adverse outcome was defined a s the occurrence of any of the following: death within 30 days, death befor e discharge from the hospital, paraplegia, paraparesis, stroke, or acute re nal failure requiring dialysis. A risk factor analysis was performed using data from 1,108 consecutive elective thoracoabdominal aortic aneurysm repai rs. Results. The incidence of an adverse outcome was 13.0% (144 of 1,108 patien ts); predictors included preoperative renal insufficiency (p = 0.0001), inc reasing age (p = 0.0035), symptomatic aneurysms (p = 0.020), and extent II aneurysms (p = 0.0001). These risk factors were used to construct an equati on that estimates the probability of an adverse outcome for an individual p atient. Conclusions. This new predictive model may assist in decisions regarding el ective thoracoabdominal aortic aneurysm operations. For patients who are ac ceptable candidates, contemporary surgical management provides favorable re sults. (C) 2001 by The Society of Thoracic Surgeons.