Short-term outcomes of open surgical abdominal aortic aneurysm repair from the Dutch Surgical Aneurysm Audit
Authors: Geraedts A C M , Alberga A J , Koelemay M J W , Verhagen H J M , Vahl A C , Balm R ,   Dutch Society for Vascular Surgery, van den Akker P J , Akkersdijk G P , Akkersdijk W L , van Andringa de Kempenaer M G , Arts C H P , Avontuur A M , Bakker O J , Balm R , Barendregt W B , Bekken J A , Bender M H M , Bendermacher B L W , van den Berg M , Beuk R J , Blankensteijn J D , Bode A S , Bodegom M E , van der Bogt K E A , Boll A P M , Booster M H , Borger van der Burg B L S , de Borst G J , Bos- van Rossum W T G J , Bosma J , Botman J M J , Bouwman L H , Brehm V , de Bruijn M T , de Bruin J L , Brummel P , van Brussel J P , Buijk S E , Buimer M G , Buscher H C J L , Cancrinus E , Castenmiller P H , Cazander G , Cuypers Ph W M , Daemen J H C , Dawson I , Dierikx J E , Dijkstra M L , Diks J , Dinkelman M K , Dirven M , Dolmans D E J G J , van Dortmont L M C , Drouven J W , van der Eb M M , Eefting D , van Eijck G J W M , Elshof J W M , Elsman B H P , van der Elst A , van Engeland M I A , van Eps G S , Faber M J , de Fijter W M , Fioole B , Fritschy W M , Fung Kon Jin P H P , Geelkerken R H , van Gent W B , Glade G J , Govaert B , Groenendijk R P R , de Groot H G W , van den Haak R F F , de Haan E F A , Hajer G F , Hamming J F , van Hattum E S , Hazenberg C E V B , Hedeman Joosten P Ph A , Helleman J N , van der Hem L G , Hendriks J M , van Herwaarden J A , Heyligers J M M , Hinnen J W , Hissink R J , Ho G H , den Hoed P T , Hoedt M T C , van Hoek F , Hoencamp R , Hoffmann W H , Hoksbergen A W J , Hollander E J F , Huisman L C , Hulsebos R G , Huntjens K M B , Idu M M , Jacobs M J H M , van der Jagt M F P , Jansbeken J R H , Janssen R J L , Jiang H H L , de Jong S C , Jongbloed-Winkel T A , Jongkind V , Kapma M R , Keller B P J A , Khodadade Jahrome A , Kievit J K , Klemm P L , Klinkert Jr. P , Koedam N A , Koelemaij M J W , Kolkert J L P , Koning G G , Koning O H J , Konings R , Krasznai A G , Kropman R H J , Kruse R R , van der Laan L , van der Laan M J , van Laanen J H H , van Lammeren G W , Lamprou D A A , Lardenoije J H P , Lauret G J , Leenders B J M , Legemate D A , Leijdekkers V J , Lemson M S , Lensvelt M M A , Lijkwan M A , van der Linden F Th P M , Liqui Lung P F , Loos M J A , Loubert M C , van de Luijtgaarden K M , Mahmoud D E A K , Manshanden C G , Mattens E C J L , Meerwaldt R , Mees B M E , Menting T P , Metz R , de Mol van Otterloo J C A , Molegraaf M J , Montauban van Swijndregt Y C A , Morak M J M , van de Mortel R H W , Mulder W , Nagesser S K , Naves C C L M , Nederhoed J H , Nevenzel A M , de Nie A J , Nieuwenhuis D H , van Nieuwenhuizen R C , Nieuwenhuizen J , Nio D , Oomen A P A , Oranen B I , Oskam J , Palamba H W , Peppelenbosch A G , van Petersen A S , Petri B J , Pierie M E N , Ploeg A J , Pol R A , Ponfoort E D , Poyck P P C , Prent A , ten Raa S , Raymakers J T F J , Reichmann B L , Reijnen M M P J , de Ridder J A M , Rijbroek A , van Rijn M J E , de Roo R A , Rouwet E V , Saleem B R , van Sambeek M R H M , Samyn M G , van�t Sant H P , van Schaik J , van Schaik P M , Scharn D M , Scheltinga M R M , Schepers A , Schlejen P M , Schl�sser F J V , Schol F P G , Scholtes V P W , Schouten O , Schreve M A , Schurink G W H , Sikkink C J J M , Te Slaa A , Smeets H J , Smeets L , Smeets R R , de Smet A A E A , Smit P C , Smits T M , Snoeijs M G J , Sondakh A O , Speijers M J , van der Steenhoven T J , van Sterkenburg S M M , Stigter D A A , Stokmans R A , Strating R P , Stulti�ns G N M , Sybrandy J E M , Teijink J A W , Telgenkamp B J , Testroote M J G , Tha-In T , The R M , Thijsse W J , Thomassen I , Tielliu I F J , van Tongeren R B M , Toorop R J , Tournoij E , Truijers M , T�rkcan K , Tutein Nolthenius R P , �nl� C , Vaes R H D , Vahl A C , Veen E J , Veger H T C , Veldman M G , Verhagen H J M , Verhoeven B A N , Vermeulen C F W , Vermeulen E G J , Vierhout B P , van der Vijver-Coppen R J , Visser M J T , van der Vliet J A , van Vlijmen-van Keulen C J , van der Vorst J R , Vos A W F , Vos C G , Vos G A , de Vos B , Vo�te M T , Vriens B H R , Vriens P W H E , de Vries D K , de Vries J P P M , de Vries M , de Vries A C , van der Waal C , Waasdorp E J , Wallis de Vries B M , van Walraven L A , van Wanroi J L , Warl� M C , van Weel V , van Well A M E , Welten G M J M , Wever J J , Wiersema A M , Wikkeling O R M , Willaert W I M , Wille J , Willems M C M , Willigendael E M , Wilschut E D , Wisselink W , Witte M E , Wittens C H A , Wong C Y , Yazar O , Yeung K K , Zeebregts C J A M , van Zeeland M L P 
Published: August 2021

Abstract

Background
The sharp decrease in open surgical repair (OSR) for abdominal aortic aneurysm (AAA) has raised concerns about contemporary postoperative outcomes. The study was designed to analyse the impact of complications on clinical outcomes within 30 days following OSR.

Methods
Patients who underwent OSR for intact AAA registered prospectively between 2016 and 2019 in the Dutch Surgical Aneurysm Audit were included. Complications and outcomes (death, secondary interventions, prolonged hospitalization) were evaluated. The adjusted relative risk (aRr) and 95 per cent confidence intervals were computed using Poisson regression. Subsequently, the population-attributable fraction (PAF) was calculated. The PAF reflects the expected percentage reduction of an outcome if a complication were to be completely prevented.

Results
A total of 1657 patients were analysed. Bowel ischaemia and renal complications had the largest impact on death (aRr 12·44 (95 per cent c.i. 7·95 to 19·84) at PAF 20 (95 per cent c.i. 8·4 to 31·5) per cent and aRr 5·07 (95 per cent c.i. 3·18 to 8.07) at PAF 14 (95 per cent c.i. 0·7 to 27·0) per cent, respectively). Arterial occlusion had the greatest impact on secondary interventions (aRr 11·28 (95 per cent c.i. 8·90 to 14·30) at PAF 21 (95 per cent c.i. 14·7 to 28·1) per cent), and pneumonia (aRr 2·52 (95 per cent c.i. 2·04 to 3·10) at PAF 13 (95 per cent c.i. 8·3 to 17·8) per cent) on prolonged hospitalization. Small effects were observed on outcomes for other complications.

Conclusion
The greatest clinical impact following OSR can be made by focusing on measures to reduce the occurrence of bowel ischaemia, arterial occlusion and pneumonia.