Abstract：
BACKGROUND: Anemia is a highly prevalent condition potentially linked to chronic inflammation. Preoperative anemia is an independent risk factor across many surgical fields. However, the relationship between anemia and abdominal aortic aneurysm (AAA) repair outcomes remains unclear. This study aimed to examine the effects of preoperative anemia on 30-day outcomes of non-ruptured infrarenal AAA repair.
METHODS: Patients who underwent open surgical repair (OSR) and endovascular aneurysm repair (EVAR) for infrarenal AAA were identified in National Surgical Quality Improvement Program (NSQIP) targeted databases from 2012 to 2021. Anemia was defined as preoperative hematocrit less than 39% in males and 36% in females. Multivariable logistic regression was used to compare 30-day perioperative outcomes between anemic and non-anemic patients, adjusting for demographics, comorbidities, indications, aneurysm extents, operation time, and surgical approaches.
RESULTS: There were 408 (22.13%) anemic and 1436 (77.88%) non-anemic patients who underwent OSR for non-ruptured AAA, while 3586 (25.20%) patients with and 10,644 (74.80%) without anemia underwent EVAR. In both OSR and EVAR, anemic patients had higher risks of bleeding requiring transfusion (OSR, aOR = 2.446, p < .01; EVAR, aOR = 3.691, p < .01), discharge not to home (OSR, aOR = 1.385, p = .04; EVAR, aOR = 1.27, p < .01), and 30-day readmission (OSR, aOR = 1.99, p < .01; EVAR, aOR = 1.367, p < .01). Also, anemic patients undergoing OSR had higher pulmonary events (aOR = 2.192, p < .01), sepsis (aOR = 2.352, p < .01), and venous thromboembolism (aOR = 2.913, p = .01), while in EVAR, anemic patients had higher mortality (aOR = 1.646, p = .01), cardiac complications (aOR = 1.39, p = .04), renal dysfunction (aOR = 1.658, p = .02), and unplanned reoperation (aOR = 1.322, p = .01). Moreover, in both OSR and EVAR, anemic patients had longer hospital length of stay (p < .01).
CONCLUSIONS: In OSR and EVAR, preoperative anemia was independently associated with worse 30-day outcomes. Preoperative anemia could be a useful marker for risk stratification for patients undergoing infrarenal AAA repair.
METHODS: Patients who underwent open surgical repair (OSR) and endovascular aneurysm repair (EVAR) for infrarenal AAA were identified in National Surgical Quality Improvement Program (NSQIP) targeted databases from 2012 to 2021. Anemia was defined as preoperative hematocrit less than 39% in males and 36% in females. Multivariable logistic regression was used to compare 30-day perioperative outcomes between anemic and non-anemic patients, adjusting for demographics, comorbidities, indications, aneurysm extents, operation time, and surgical approaches.
RESULTS: There were 408 (22.13%) anemic and 1436 (77.88%) non-anemic patients who underwent OSR for non-ruptured AAA, while 3586 (25.20%) patients with and 10,644 (74.80%) without anemia underwent EVAR. In both OSR and EVAR, anemic patients had higher risks of bleeding requiring transfusion (OSR, aOR = 2.446, p < .01; EVAR, aOR = 3.691, p < .01), discharge not to home (OSR, aOR = 1.385, p = .04; EVAR, aOR = 1.27, p < .01), and 30-day readmission (OSR, aOR = 1.99, p < .01; EVAR, aOR = 1.367, p < .01). Also, anemic patients undergoing OSR had higher pulmonary events (aOR = 2.192, p < .01), sepsis (aOR = 2.352, p < .01), and venous thromboembolism (aOR = 2.913, p = .01), while in EVAR, anemic patients had higher mortality (aOR = 1.646, p = .01), cardiac complications (aOR = 1.39, p = .04), renal dysfunction (aOR = 1.658, p = .02), and unplanned reoperation (aOR = 1.322, p = .01). Moreover, in both OSR and EVAR, anemic patients had longer hospital length of stay (p < .01).
CONCLUSIONS: In OSR and EVAR, preoperative anemia was independently associated with worse 30-day outcomes. Preoperative anemia could be a useful marker for risk stratification for patients undergoing infrarenal AAA repair.
摘要：
背景：贫血是一种可能与慢性炎症相关的非常普遍的疾病。术前贫血是许多手术领域的独立危险因素。然而,贫血与腹主动脉瘤(AAA)修复结局之间的关系尚不清楚.本研究旨在研究术前贫血对未破裂肾下AAA修复30天预后的影响。
方法：在2012年至2021年的国家手术质量改善计划（NSQIP）目标数据库中确定了接受开放手术修复（OSR）和腔内动脉瘤修复（EVAR）治疗肾下AAA的患者。贫血定义为术前红细胞压积低于男性39%，女性36%。多变量logistic回归用于比较贫血和非贫血患者30天的围手术期结果。适应人口统计，合并症,适应症,动脉瘤范围，操作时间,和手术方法。
结果：有408例（22.13%）贫血和1436例（77.88%）非贫血患者因未破裂AAA而接受OSR，3586例(25.20%)贫血患者和10,644例(74.80%)无贫血患者接受了EVAR。在OSR和EVAR中，贫血患者需要输血的出血风险较高(OSR，OR=2.446,p<.01;EVAR,OR=3.691,p<.01),不在家放电(OSR，OR=1.385,p=.04;EVAR,OR=1.27,p<.01),和30天重新接纳(OSR，aOR=1.99,p<.01;EVAR,OR=1.367,p<.01)。此外，接受OSR的贫血患者的肺部事件较高（aOR=2.192，p<0.01），败血症（aOR=2.352，p<0.01），和静脉血栓栓塞（aOR=2.913，p=0.01），而在EVAR,贫血患者死亡率较高(aOR=1.646,p=0.01),心脏并发症（aOR=1.39，p=.04），肾功能不全（aOR=1.658，p=0.02），和计划外的再操作(aOR=1.322，p=0.01)。此外，在OSR和EVAR中，贫血患者住院时间较长(p<.01).
结论：在OSR和EVAR中，术前贫血与不良的30日结局独立相关.术前贫血可能是进行肾下AAA修复的患者的风险分层的有用标记。
方法：在2012年至2021年的国家手术质量改善计划（NSQIP）目标数据库中确定了接受开放手术修复（OSR）和腔内动脉瘤修复（EVAR）治疗肾下AAA的患者。贫血定义为术前红细胞压积低于男性39%，女性36%。多变量logistic回归用于比较贫血和非贫血患者30天的围手术期结果。适应人口统计，合并症,适应症,动脉瘤范围，操作时间,和手术方法。
结果：有408例（22.13%）贫血和1436例（77.88%）非贫血患者因未破裂AAA而接受OSR，3586例(25.20%)贫血患者和10,644例(74.80%)无贫血患者接受了EVAR。在OSR和EVAR中，贫血患者需要输血的出血风险较高(OSR，OR=2.446,p<.01;EVAR,OR=3.691,p<.01),不在家放电(OSR，OR=1.385,p=.04;EVAR,OR=1.27,p<.01),和30天重新接纳(OSR，aOR=1.99,p<.01;EVAR,OR=1.367,p<.01)。此外，接受OSR的贫血患者的肺部事件较高（aOR=2.192，p<0.01），败血症（aOR=2.352，p<0.01），和静脉血栓栓塞（aOR=2.913，p=0.01），而在EVAR,贫血患者死亡率较高(aOR=1.646,p=0.01),心脏并发症（aOR=1.39，p=.04），肾功能不全（aOR=1.658，p=0.02），和计划外的再操作(aOR=1.322，p=0.01)。此外，在OSR和EVAR中，贫血患者住院时间较长(p<.01).
结论：在OSR和EVAR中，术前贫血与不良的30日结局独立相关.术前贫血可能是进行肾下AAA修复的患者的风险分层的有用标记。
