METHODS: This was a single centre observational cohort study. The study included all patients treated for rAAA followed by OAT from October 2006 to December 2021.
RESULTS: Seventy-two of the 244 patients who underwent surgery for rAAA received OAT. The mean age was 72 ± 7.85 years, and most were male (n = 61, 85%). The most frequent comorbidities were cardiac disease (n = 31, 43%) and hypertension (n = 31, 43%). Fifty-two patients (72%) received prophylactic OAT, and 20 received OAT for ACS (28%). There was a 25% mortality rate in the prophylactic OAT group compared with the 50% mortality in those who received OAT for ACS (p = .042). The 58 (81%) patients who survived until closure had a median of 12 (interquartile range [IQR] 9, 16.5) days of OAT and 5 (IQR 4, 7) dressing changes. There was one case of colocutaneous fistula and two cases of graft infection. All 58 patients underwent successful abdominal closure, with 55 (95%) undergoing delayed primary closure. In hospital survival was 85%. Treatment trends over time showed the increased use of prophylactic OAT (p ≤ .001) and fewer ACS cases (p = .03) assessed by Fisher\'s exact test. In multivariable regression analysis fluid overload and weight reduction predicted 26% of variability in time to closure.
CONCLUSIONS: Prophylactic OAT after rAAA can be performed safely, with a high rate of delayed primary closure even after long term treatment.
方法:这是一项单中心观察性队列研究。该研究包括2006年10月至2021年12月接受rAAA和OAT治疗的所有患者。
结果:244例接受rAAA手术的患者中有72例接受了OAT。平均年龄72±7.85岁,大多数是男性(n=61,85%)。最常见的合并症是心脏病(n=31,43%)和高血压(n=31,43%)。52例患者(72%)接受预防性OAT,20人接受了ACS的OAT(28%)。预防性OAT组的死亡率为25%,而接受OAT治疗的ACS患者的死亡率为50%(p=.042)。存活至关闭的58例(81%)患者的OAT中位天数为12天(四分位距[IQR]9,16.5天),换药天数为5天(IQR4,7)。共有1例皮肤瘘和2例移植物感染。所有58例患者均成功进行了腹部闭合,55(95%)进行延迟初次闭合。医院生存率为85%。随着时间的推移,治疗趋势显示,通过Fisher精确检验评估,预防性OAT的使用增加(p≤.001),ACS病例减少(p=.03)。在多变量回归分析中,液体超负荷和体重减轻可预测闭合时间的变异性为26%。
结论:rAAA后的预防性OAT可以安全地进行,即使在长期治疗后,延迟的原发性闭合率也很高。