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• W4280493217 abstract "Interfacility transfer (IFT) of patients with ruptured abdominal aortic aneurysms (rAAAs) is an important management option for patients presenting to centers where optimal care is unavailable. The aim of this study was to assess the impact of IFT on postoperative outcomes of patients undergoing rAAA repair using multi-institutional registry data. A retrospective review of the Vascular Quality Initiative database of all patients who had undergone rAAA repair between 2011 and 2021 was undertaken. The primary outcome was in-hospital death. The secondary outcomes included rates of postoperative myocardial infarction, permanent dialysis, lower extremity ischemia, and bowel ischemia. Logistic regression modeling was used to control for confounding variables. A total of 6049 rAAA repairs were analyzed, of which 3769 patients (62.3%) had been transferred (IFT) and 2280 (37.7%) had been treated at the initial hospital (NIFT). Compared with the IFT patients, the NIFT patients were significantly more likely to be non-White (14.7% vs 12.0%; P = .002) and Hispanic or Latino (3.5% vs 2.5%; P = .026). The IFT patients demonstrated significantly higher rates of smoking (46.5% vs 44.8%; P = .017) and chronic obstructive pulmonary disease (31.0% vs 28.4%; P = .030). In contrast, the NIFT patients had significantly higher rates of congestive heart failure (12.2% vs 10.5%; P = .049) and greater rates of statin use (45.4% vs 42.2%; P = .018) and beta-blocker use (38.3% vs 35.3%; P = .022; Table I). In-hospital death was significantly higher for the NIFT patients (28.5% vs 25.5%; P = .011). The rates of postoperative myocardial infarction, permanent dialysis, lower extremity ischemia, and bowel ischemia did not significantly differ between the two groups. After adjusting for potential confounders, the IFT patients were 20% less likely to experience in-hospital death (adjusted odds ratio, 0.80; 95% confidence interval, 0.7-0.9; P = .009; Table II). A subanalysis of postoperative outcomes stratified by repair type revealed a significantly lower in-hospital death rate for IFT patients who had undergone open aortic repair (adjusted odds ratio, 0.8; 95% confidence interval, 0.6-0.9; P = .038). However, for patients who had undergone endovascular aneurysm repair, the rate of in-hospital death did not significantly differ between the IFT and NIFT patients (P = .077). More than 60% of rAAA repairs are performed after IFT; however, IFT does not adversely affect the postoperative outcomes. Although timely management of rAAA is mandatory, prompt transfer of patients to a higher level of care might provide survival benefit, especially for patients needing open repair.Table IBaseline and clinical characteristics stratified by interfacility transfer (IFT)CharacteristicIFT (n = 3769; 62.3%)NIFT (n = 2280; 37.7%)P valueAge, years72.5 ± 9.772.4 ± 9.7.885Male sex2903 (77.0)1750 (76.8).833Race (non-White)450 (12.0)335 (14.7).002Ethnicity (Hispanic or Latino)93 (2.5)79 (3.5).026Obesity1408 (37.4)836 (36.7).590Insurance.347 Medicare2099 (58.9)1238 (57.6) Medicaid114 (3.2)82 (3.8) Other1348 (37.9)831 (38.6)Smoking.017 Never713 (19.3)504 (22.4) Prior1259 (34.1)738 (32.8) Current1717 (46.5)1006 (44.8)Comorbidity HTN2848 (77.2)1733 (77.2).988 DM555 (14.9)377 (16.7).060 CAD787 (21.2)489 (21.8).605 Prior CABG/PCI803 (21.6)518 (23.0).199 CHF391 (10.5)274 (12.2).049 COPD1154 (31.0)638 (28.4).030 Dialysis39 (1.0)28 (1.2).481 CKD2015 (56.6)1285 (58.3).203 Nonambulatory33 (1.5)16 (1.2).417Medication Aspirin1448 (39.5)887 (39.6).892 P2Y12 inhibitor304 (8.3)197 (8.8).483 Statin1550 (42.2)1015 (45.4).018 Beta-blocker1296 (35.3)856 (38.3).022 RAAS inhibitor110 (31.7)653 (30.8).457 Anticoagulant432 (12.4)274 (12.9).590Iliac artery aneurysm786 (21.9)528 (24.1).062Minimum SBP, mm Hg92.4 ± 32.591.9 ± 33.8.577Mental status.088 Normal2817 (76.2)1681 (74.6) Disoriented455 (12.3)322 (14.3) Unconscious426 (11.5)251 (11.1)Anesthesia.049 Local1754 (46.2)993 (43.6) Regional64 (1.7)46 (2.0) General1936 (51.6)1240 (54.4)Cardiac arrest370 (9.9)231 (10.2).683Conversion to open128 (3.5)65 (2.9).232Surgery type (EVAR)2350 (62.4)1438 (63.1).575Clamp<.001 Endovascular2350 (63.3)1438 (64.1) Infrarenal629 (17.0)459 (20.5) Suprarenal417 (11.2)205 (9.1) Supraceliac316 (8.5)142 (6.3)CABG, Coronary artery bypass graft; CAD, coronary artery disease; CHF, congestive heart failure; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; DM, diabetes mellitus; EVAR, endovascular aortic repair; HTN, hypertension; NIFT, no interfacility transfer; PCI, percutaneous coronary intervention; RAAS, renin-angiotensin-aldosterone system; SBP, systolic blood pressure. Open table in a new tab Table IIPostoperative outcomes of ruptured abdominal aortic aneurysm (rAAA) repair stratified by interfacility transfer (IFT)OutcomeUnadjusted, No. (%)AdjustedIFT (n = 3769; 62.3%)NIFT (n = 2280; 37.7%)P valueaORa (95% CI)P valueIn-hospital death960 (25.5)649 (28.5).0110.8 (0.7-0.9).009Postoperative MI400 (11.0)214 (9.7).1341.2 (0.9-1.4).196Postoperative PD140 (3.9)82 (3.7).8101.1 (0.8-1.5).562Postoperative LEI184 (5.1)115 (5.2).7781.0 (0.8-1.2).726Postoperative BI381 (10.5)211 (9.6).2761.1 (0.9-1.4).321aOR, Adjusted odds ratio; BI, bowel ischemia; CI, confidence interval; LEI, lower extremity ischemia; MI, myocardial infarction; NIFT, no interfacility transfer; PD, permanent dialysis.aReference, IFT. Open table in a new tab" @default.
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• W4280493217 date "2022-06-01" @default.
• W4280493217 modified "2023-09-30" @default.
• W4280493217 title "The Impact of Interfacility Transfer on Postoperative Outcomes of Ruptured Abdominal Aortic Aneurysm Repair" @default.
• W4280493217 doi "https://doi.org/10.1016/j.jvs.2022.03.162" @default.
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