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

Castigliano M Bhamidipati; Beth C Tohill; Charee Robe; Kimberly J Reid; Nicholas C Eglitis; Mark A Farber; William D Jordan Jr

doi:10.1016/j.jvscit.2023.101174

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

J Vasc Surg Cases Innov Tech. 2023 Apr 22;9(2):101174. doi: 10.1016/j.jvscit.2023.101174. eCollection 2023 Jun.

Authors

Castigliano M Bhamidipati¹, Beth C Tohill², Charee Robe², Kimberly J Reid², Nicholas C Eglitis³, Mark A Farber⁴, William D Jordan Jr⁵

Affiliations

¹ Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR.
² W.L. Gore & Associates, Flagstaff, AZ.
³ Division of Cardiac Anesthesia and Critical Care, Oregon Health & Science University, Portland, OR.
⁴ Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC.
⁵ Division of Vascular Surgery, Emory University, Atlanta, GA.

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.

Keywords: Complications; Discharge; Mortality; Rehospitalization; Thoracic endovascular repair.