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Abstract：
BACKGROUND: The operative outcomes of thoracoabdominal aortic aneurysms (TAAAs) are challenged by high operative mortality and disabling complications. This study aimed to explore the baseline clinical, anatomical, and procedural risk factors that impact early and late outcomes following open repair of TAAAs.
METHODS: We reviewed the medical records of 290 patients who underwent open repair of TAAAs between 1992 and 2020 at a tertiary referral center. Determinants of early mortality (within 30 days or in hospital) were analyzed using multivariable logistic regression models, while those of overall follow-up mortality were explored using multivariable Cox proportional hazards models and landmark analyses.
RESULTS: The rates of early mortality and spinal cord deficits were 13.1% and 11.0%, respectively, with Crawford extent II showing the highest rates. In the logistic regression models, older age (P < 0.001), high cardiopulmonary bypass (CPB) time (P < 0.001), and low surgical volume of the surgeon (P < 0.001) emerged as independent factors significantly associated with early mortality. During follow-up (median, 5.0 years; interquartile range, 1.1-7.6 years), 82 late deaths occurred (5.7%/patient-year). Cox proportional hazards models demonstrated that older age (P < 0.001) and low hemoglobin level (P = 0.032) were significant risk factors of overall mortality, while the landmark analyses revealed that the significant impacts of low surgical volume (P = 0.017), high CPB time (P = 0.002), and Crawford extent II (P = 0.017) on mortality only remained in the early postoperative period, without significant late impacts (all P > 0.05).
CONCLUSIONS: There were differential temporal impacts of perioperative risk variables on mortality in open repair of TAAAs, with older age and low hemoglobin level having significant impacts throughout the postoperative period, and low surgical volume, high CPB time, and Crawford extent II having impacts in the early postoperative phase.
METHODS: We reviewed the medical records of 290 patients who underwent open repair of TAAAs between 1992 and 2020 at a tertiary referral center. Determinants of early mortality (within 30 days or in hospital) were analyzed using multivariable logistic regression models, while those of overall follow-up mortality were explored using multivariable Cox proportional hazards models and landmark analyses.
RESULTS: The rates of early mortality and spinal cord deficits were 13.1% and 11.0%, respectively, with Crawford extent II showing the highest rates. In the logistic regression models, older age (P < 0.001), high cardiopulmonary bypass (CPB) time (P < 0.001), and low surgical volume of the surgeon (P < 0.001) emerged as independent factors significantly associated with early mortality. During follow-up (median, 5.0 years; interquartile range, 1.1-7.6 years), 82 late deaths occurred (5.7%/patient-year). Cox proportional hazards models demonstrated that older age (P < 0.001) and low hemoglobin level (P = 0.032) were significant risk factors of overall mortality, while the landmark analyses revealed that the significant impacts of low surgical volume (P = 0.017), high CPB time (P = 0.002), and Crawford extent II (P = 0.017) on mortality only remained in the early postoperative period, without significant late impacts (all P > 0.05).
CONCLUSIONS: There were differential temporal impacts of perioperative risk variables on mortality in open repair of TAAAs, with older age and low hemoglobin level having significant impacts throughout the postoperative period, and low surgical volume, high CPB time, and Crawford extent II having impacts in the early postoperative phase.
摘要：
背景：胸腹主动脉瘤（TAAA）的手术结果受到高手术死亡率和致残并发症的挑战。本研究旨在探索基线临床，解剖学,以及影响开放修复TAAA后早期和晚期结果的程序风险因素。
方法：我们回顾了1992年至2020年间在三级转诊中心接受TAAA开放性修复的290例患者的医疗记录。使用多变量逻辑回归模型分析早期死亡率（30天内或住院）的决定因素，而使用多变量Cox比例风险模型和界标分析对总体随访死亡率进行了调查.
结果:早期死亡率和脊髓缺损率分别为13.1%和11.0%,分别,克劳福德程度II显示最高的比率。在逻辑回归模型中，年龄较大（P<0.001），体外循环（CPB）时间（P<0.001），手术量低(P<0.001)是与早期死亡率显著相关的独立因素。在随访期间(中位数，5.0年；四分位数范围，1.1-7.6年)，82例晚期死亡（5.7%/患者年）。Cox比例风险模型表明，年龄（P<0.001）和低血红蛋白水平（P=0.032）是总死亡率的重要危险因素。而具有里程碑意义的分析表明，低手术量(P=0.017)的显著影响，高CPB时间（P=0.002），而克劳福德程度Ⅱ(P=0.017)对死亡率仅保留在术后早期,无明显的后期影响(均P>0.05)。
结论：围手术期风险变量对开放修复TAAA的死亡率有不同的时间影响，高龄和低血红蛋白水平在整个术后期间都有显著影响，低手术量，CPB时间高,和克劳福德程度II在术后早期有影响。
方法：我们回顾了1992年至2020年间在三级转诊中心接受TAAA开放性修复的290例患者的医疗记录。使用多变量逻辑回归模型分析早期死亡率（30天内或住院）的决定因素，而使用多变量Cox比例风险模型和界标分析对总体随访死亡率进行了调查.
结果:早期死亡率和脊髓缺损率分别为13.1%和11.0%,分别,克劳福德程度II显示最高的比率。在逻辑回归模型中，年龄较大（P<0.001），体外循环（CPB）时间（P<0.001），手术量低(P<0.001)是与早期死亡率显著相关的独立因素。在随访期间(中位数，5.0年；四分位数范围，1.1-7.6年)，82例晚期死亡（5.7%/患者年）。Cox比例风险模型表明，年龄（P<0.001）和低血红蛋白水平（P=0.032）是总死亡率的重要危险因素。而具有里程碑意义的分析表明，低手术量(P=0.017)的显著影响，高CPB时间（P=0.002），而克劳福德程度Ⅱ(P=0.017)对死亡率仅保留在术后早期,无明显的后期影响(均P>0.05)。
结论：围手术期风险变量对开放修复TAAA的死亡率有不同的时间影响，高龄和低血红蛋白水平在整个术后期间都有显著影响，低手术量，CPB时间高,和克劳福德程度II在术后早期有影响。
