7. A NEW PREDICTIVE MODEL FOR UNFAVORABLE OUTCOMES AFTER ELECTIVE THORACOABDOMINAL AORTIC ANEURYSM REPAIR
Joseph S. Coselli*, Scott A. LeMaire, Charles C. Miller, III, Zachary C. Schmittling, Cuneyt Koksoy, Jose Pagan
Baylor College of Medicine/ The Methodist Hospital
Houston, Texas, USA
BACKGROUND
Recent recommendations regarding thoracoabdominal aortic aneurysm (TAAA) management have emphasized individualized treatment based on balancing a patientÂ’s risk of rupture with their risk of an unfavorable outcome following surgical repair. The purpose of this study was to enhance this risk-benefit decision by determining which preoperative risk factors currently predict an unfavorable outcome after elective TAAA surgery.
MATERIAL AND METHODS
A single, composite endpoint termed "unfavorable outcome" was defined as the occurrence of any of the following: death within 30 days, death prior to discharge from the hospital, paraplegia, paraparesis, stroke, or acute renal failure requiring dialysis. Based on data from 1,108 consecutive elective TAAA operations from 1986 through 1998, a risk factor analysis was performed using multiple stepwise logistic regression with confirmatory forward manual selection.
RESULTS
The incidence of an unfavorable outcome was 13.0% (144/1,108); predictors included preoperative renal insufficiency (P = 0.0001), increasing age (P = 0.0035), symptomatic aneurysms (P = 0.020), and extent II aneurysms (P = 0.0001). These risk factors were used to construct an equation that estimates the probability of an unfavorable outcome for an individual patient.
CONCLUSION
This new predictive model may assist in decisions regarding elective TAAA operations. For patients who are acceptable candidates, contemporary surgical management provides favorable results.
