Physiologic risk stratification is important to long-term mortality, complications, and readmission in thoracic endovascular aortic repair

• Type of Material: Article
• Authors: William Jordan Jr, Emory University; Castigliano M Bhamidipati, Oregon Health & Science University; Beth C Tohill, W.L. Gore & Associates, Flagstaff, AZ; Charee Robe, W.L. Gore & Associates, Flagstaff, AZ; Kimberly J Reid, W.L. Gore & Associates, Flagstaff, AZ; Nicholas C Eglitis, Oregon Health & Science University; Mark A Farber, The University of North Carolina at Chapel Hill; William D Jordan, Emory University
• Language: English
• Date: 2023-06-01
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Author(s)
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jvscit.2023.101174
• Title of Journal or Parent Work: Journal of Vascular Surgery Cases, Innovations and Techniques
• Volume: 9
• Issue: 2
• Start Page: 101174
• End Page: 101174
• Keywords: Complications; Discharge; Mortality; Rehospitalization; Thoracic endovascular repair
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Use of the American Society of Anesthesiologists (ASA) physical status classification is important for periprocedural risk stratification. However, the collective effect after adjustment for the Society for Vascular Surgery (SVS) medical comorbidity grading system on long-term all-cause mortality, complications, and discharge disposition is unknown. We examined these associations in patients after thoracic endograft placement. Data from three thoracic endovascular aortic repair (TEVAR) trials through 5 years of follow-up were included. Patients with acute complicated type B dissection (n = 50), traumatic transection (n = 101), or descending thoracic aneurysm (n = 66) were analyzed. The patients were stratified into three groups according to the ASA class: I-II, III, and IV. Multivariable proportional hazards regression models were used to examine the effect of ASA class on 5-year mortality, complications, and rehospitalizations after adjustment for SVS risk score and potential confounders. The largest proportion of patients treated by TEVAR across the ASA groups (n = 217) was ASA IV (n = 97; 44.7%; P < .001), followed by ASA III (n = 83; 38.2%) and ASA I-II (n = 37; 17.1%). Among the ASA groups, the ASA I-II patients were, on average, 6 years younger than those with ASA III and 3 years older than those with ASA IV (ASA I-II: age, 54.3 ± 22.0 years; ASA III: age, 60.0 ± 19.7 years; ASA IV: age, 51.0 ± 18.4 years; P = .009). Multivariable adjusted 5-year outcome models showed that ASA class IV, independent of the SVS score, conferred an increased risk of mortality (hazard ratio [HR], 3.83; 95% confidence interval [CI], 1.19-12.25; P = .0239) and complications (HR, 4.53; 95% CI, 1.69-12.13; P = .0027) but not rehospitalization (HR, 1.84; 95% CI, 0.93-3.68; P = .0817) compared with ASA class I-II. Procedural ASA class is associated with long-term outcomes among post-TEVAR patients, independent of the SVS score. The ASA class and SVS score remain important to patient counseling and postoperative outcomes beyond the index operation.