6 research outputs found
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Racial disparities in presentation and outcomes for endovascular abdominal aortic aneurysm repair
In the present study, we used a national database to identify racial differences in the presentation and outcomes for patients undergoing endovascular abdominal aortic aneurysm (AAA) repair (EVAR) and identified areas for improving their care.
We queried the EVAR-targeted National Surgical Quality Improvement Program database (2016-2019) to identify patients who had undergone EVAR for both ruptured and nonruptured AAAs. The patients were categorized according to race (White, Black, and Asian). Patients with a history of abdominal aortic surgery or an indication other than AAAs were excluded. The data was analyzed using the χ2 and Kruskal-Wallis tests, presented as frequencies and percentages or median and interquartile range (IQR) for categorical and continuous variables, respectively.
We identified 3629 patients (16.6% female), including 3312 White (91.3%), 248 Black (6.8%), and 69 Asian (1.9%) patients. Black patients were more frequently women (27.0%) compared with White patients (15.9%) and were younger (median age, 71 years; IQR, 64-77 years) than White (median age, 73 years; IQR, 67-79 years) and Asian (median age, 76 years; IQR, 67-81 years) patients (P 1 day after both elective and nonelective EVAR and 30-day readmission for elective EVAR, but not 30-day mortality after elective and nonelective EVAR.
In the present nationwide sample of EVAR cases, Black patients were more often women and younger. Despite similar rates of symptomatic and ruptured AAAs at presentation and 30-day mortality, Black patients more often presented and were treated during the same nonelective admission; they also had associated increased length of hospital stay and readmission. These findings signal a missed opportunity to diagnose, optimize, and treat this particular group of patients in an elective setting
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Effect of Body Mass Index on Early Outcomes of Endovascular Abdominal Aortic Aneurysm Repair
This study compares the presentation, management, and outcomes of patients undergoing endovascular abdominal aortic aneurysm repair (EVAR), based on their weight status as defined by their body mass index (BMI).
Patients with primary EVAR for ruptured and intact abdominal aortic aneurysm (AAA) were identified in the National Surgical Quality Improvement Program database (2016-2019). Patients were categorized by weight status (underweight: BMI < 18.5 kg/m
, normal weight: 18.5-24.9 kg/m
, overweight: 25-29.9 kg/m
, Obese I: 30-34.9 kg/m
, Obese II: 35-39.9 kg/m
, Obese III: > 40 kg/m
). Preoperative characteristics and 30-day outcomes were compared.
Of 3,941 patients, 4.8% were underweight, 24.1% normal weight, 37.6% overweight, and 22.5% with Obese I, 7.8% Obese II, and 3.3% Obese III status. Underweight patients presented with larger (6.0 [5.4-7.2] cm) and more frequently ruptured (25.0%) aneurysms than normal weight patients (5.5 [5.1-6.2] cm and 4.3%, P < 0.001 for both). Pooled 30-day mortality was worse for underweight (8.5%) compared to all other weight status (1.1-3.0%, P < 0.001), but risk-adjusted analysis demonstrated that aneurysm rupture (odds ratio [OR] 15.9, 95% confidence interval [CI] 8.98-28.0) and not underweight status (OR 1.75, 95% CI 0.73-4.18) accounted for increased mortality in this population. Obese III status was associated with prolonged operative time and respiratory complications after ruptured AAA, but not 30-day mortality (OR 0.82, 95% CI 0.25-2.62).
Patients at either extreme of the BMI range had the worst outcomes after EVAR. Underweight patients represented only 4.8% of all EVARs, but 21% of mortalities, largely attributed to higher incidence of ruptured AAA at presentation. Severe obesity, on the other hand, was associated with prolonged operative time and respiratory complications after EVAR for ruptured AAA. BMI, as an independent factor, was however not predictive of mortality for EVAR
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Race-based Outcomes of Thoracic Aortic Aneurysms and Dissections in the Global Registry for Endovascular Aortic Treatment
This study characterizes racial differences in presentation, as well as short- and long-term outcomes following endovascular treatment of thoracic aortic aneurysm (TAA) and type B aortic dissection (TBAD).We queried the Gore Global Registry for Endovascular Aortic Treatment (GREAT) for thoracic endovascular aortic repairs (TEVARs) performed between 2010-2016 and followed through 2022. Pathologies represented were descending TAA, complicated TBAD, and uncomplicated TBAD. Using standard statistical tests, we compared overall and pathology-specific demographics, procedural factors, and outcomes among Black and White patients undergoing TEVAR.We identified 438 TEVAR cases, including 236 descending TAA, 121 complicated TBAD, and 74 uncomplicated TBAD. Overall, Black patients were younger and had higher incidence of renal insufficiency (P=.001), whereas White patients had more chronic obstructive pulmonary disease (P=.003) and cardiac arrhythmias (P=.037). In patients treated for descending TAA, Black patients had increased device/procedure-related complications (34.3% vs 17.4%, P=.014), conversion to open repair (2.9% vs 0%, P=.011) and type II endoleak (5.7% vs 1.0%, P=.040) but no differences in mortality, length of hospital stay, or major adverse cardiovascular events. Whereas outcomes of TEVAR for uncomplicated TBAD were comparable, Black patients more frequently presented with complicated TBAD than White patients (Black: 40.5% vs White: 24.8%, P=.008) and had subsequently greater reintervention rate (28.1% vs 12.4%, P=.012), all-cause mortality (HR 4.28, 95% CI 1.74-10.5, P=.002) and aortic-related mortality (HR 16.7, 95% CI 1.49-186, P=.022).Despite increased device- and procedure-related complications, similar short and long-term outcomes are achieved in Black and White patients undergoing TEVAR for descending TAA and uncomplicated TBAD. However, Black patients are more likely to present with, require reintervention, and suffer mortality from complicated TBAD.•Type of Research: Retrospective analysis of thoracic endovascular aortic repair (TEVAR) cases in the Gore Global Registry for Endovascular Aortic Treatment.•Key Findings: In 438 TEVAR cases for descending thoracic aortic aneurysm and dissection, Black patients presented with more complicated type B aortic dissections (B: 40.5% vs W: 24.8%). They also required more reinterventions (B: 28.1% vs W: 12.4%) and had greater all-cause (B: 37.5% vs W: 23.6%) and aortic-related (B: 9.4% vs W: 1.1%) mortality than White patients.•Take Home Message: Whereas outcomes of TEVAR for descending thoracic aortic aneurysms and uncomplicated type B aortic dissection are comparable, Black patients with complicated type B aortic dissection have greater need for reintervention and higher mortality
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Cerebral Hyperperfusion Syndrome Following Carotid Artery Stenting With Distal Embolic Protection vs Transcarotid Artery Revascularization
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Utility of Closed Suction Drains in Groin Incisions after Femoral Artery Exposure
Surgical groin wounds are at risk of delayed healing and infection, leading to costly and prolonged postoperative recoveries. This study assesses the use of closed suction drains (CSDs) as a wound care adjunct in groin incisions to prevent surgical site infections (SSI).
A single-center retrospective review was performed on 210 consecutive patients after vascular surgery with common femoral artery exposure from 2016 to 2021. The cohort was divided into 2 groups, groins with and without CSD, looking for surgical site complications. A subgroup analysis comparing postoperative outcomes between complicated and uncomplicated groin incisions within both groups was also performed.
Of 293 surgical groins, 20% (n = 59) had drains. Overall, the CSD group had higher SSI rates (14% vs. 5.6%), but also had higher proportion of smokers (92% vs. 83%; P = 0.019), diabetes (56% vs. 36%; P = 0.005), coronary artery disease (69% vs. 46%; P = 0.001), hyperlipidemia (69% vs. 51%; P = 0.01), and previous groin surgery (54% vs. 17%; P < 0.001). The higher risk of SSI was not significant after adjustment of these confounders. A separate analysis within each group showed SSI groins with CSD had lower reintervention rates (37.5%) than those without CSD (69%), as well as shorter length of hospital stay (7 [5-11] vs. 22 [7-25] days).
Our study suggests that CSDs can be a beneficial adjunct for groin wounds after common femoral artery exposure in patients with comorbidities cited above. CSDs decrease the risk of reintervention and length of hospital stay